Why are they hallucinating, picking at the sheets, trying to get out of bed or calling for dead relatives?
These behaviours can happen near the end of life.
These behaviours can happen near the end of life. They may be caused by delirium, which is a sudden change in thinking, attention and awareness. Delirium can make a person restless, frightened, confused, drowsy, agitated, or see and hear things that others cannot.
Some people who are dying also talk about people who have already died, or seem to respond to someone others cannot see. This can be upsetting for family. It does not always mean the person is afraid or in pain, but it is worth telling the care team, especially if the person seems distressed or unsafe.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
What delirium can look like
Delirium can change quickly. A person may seem settled one hour and confused the next. They may:
- not know where they are
- mix up day and night
- not recognise familiar people
- speak in a way that does not make sense
- see, hear or feel things that are not there
- pick at sheets, clothes, tubes or dressings
- try to climb out of bed when they are too weak
- call out, groan, swear or seem angry
- become very quiet and withdrawn.
Delirium can be distressing for the person and for those watching. It can also increase the risk of falls or pulling out medical equipment.
Why it happens
Near death, delirium may happen because the brain is affected by the illness and by changes in oxygen, blood flow and body chemistry. Waste products can build up as organs slow down.
Other causes can also contribute. These include infection, dehydration, constipation, urinary retention, pain, poor sleep, medicine side effects, medicine changes, alcohol or drug withdrawal, and being in an unfamiliar place.
Some causes can be treated. Others may not fully reverse when a person is in the last hours or days of life. The goal then is to keep the person safe and comfortable.
What you can do
Stay calm and speak gently. Use short sentences. Tell them your name and where they are. You might say, "It's Sam. You are in bed at home. I am here with you."
Keep the room as settled as possible. Reduce loud television, bright lights and too many visitors at once. Familiar voices, music, photos or a hand held gently may help some people. For others, too much touch or noise can make things worse.
Do not argue with a frightening belief or hallucination. If they say someone is in the room and they seem afraid, respond to the feeling: "That sounds scary. I am here with you. You are safe." If they seem comforted by seeing a dead relative, you may not need to correct them.
If they try to get out of bed, do not wrestle with them unless they are about to fall. Call staff or another adult for help. Ask the nurse how to keep them safe.
What the care team may do
The team may check for pain, constipation, bladder fullness, infection, fever, oxygen problems, medicine side effects or other causes. They may change medicines, stop medicines that no longer help, treat a reversible cause, or prescribe medicine to reduce distress or agitation.
Tell the team what you have seen, when it started, and whether it comes and goes. Mention any new medicines, missed medicines, falls, fever, constipation, urine problems, or signs of pain.
When to get help now
Contact the palliative care team, GP, nurse or aged care staff urgently if the person is distressed, trying to climb out of bed, at risk of falling, pulling at tubes, very agitated, newly confused, or suddenly much harder to wake.
Call 000 if there is a life-threatening emergency, a serious fall, a seizure, sudden collapse, or a sudden severe change in someone who was not expected to be dying. If the person is expected to die and has an after-hours plan, follow that plan and call the listed service.
You may also want to read
- Is what I'm seeing normal dying, or are they suffering?
- How long does someone have once these changes start?
- How do I know if someone who cannot speak still wants food or drink?
- Is this person dying now, and what should I do?