Is Acute Exacerbation of Terminal Restlessness Predictable Using Continuous Monitoring with a Sheet-Type Nonwearable...

Area of Science:

• Palliative Care
• Gerontology
• Oncology

Background:

• Restlessness is a frequent and distressing symptom in terminally ill cancer patients.
• Its progression near death is not well understood, often perceived as sudden.

Purpose of the Study:

• To determine if sudden worsening of terminal restlessness is preceded by detectable changes.
• To investigate continuous monitoring using a non-wearable sensor for early detection.

Main Methods:

• Secondary analysis of a prospective observational study in a Japanese palliative care unit (2019-2022).
• Utilized a sheet-type non-wearable sensor to measure activity scores for restlessness severity.
• Applied group-based trajectory modeling to night-time activity scores in the last 30 days of life.
• Compared Richmond Agitation-Sedation Scale (RASS) scores and medication use across identified patient trajectory groups.

Main Results:

• 11.1% of patients exhibited acute exacerbation of terminal restlessness before death.
• This group showed higher RASS scores and increased use of antipsychotics and benzodiazepines.
• Activity scores revealed a gradual upward trend starting ~2 weeks before death, not a sudden increase.

Conclusions:

• Approximately 10% of patients experience terminal restlessness exacerbation near death.
• Non-invasive continuous monitoring may facilitate earlier detection and prevention of restlessness exacerbation.
• Findings suggest a gradual progression preceding terminal restlessness events.