All illness is accompanied by some level of anxiety. Patients on hospice often experience end-of-life anxiety, attributed to not only intense pain, shortness of breath, and anticipation of what might happen next in their disease process, but in knowing their life is coming to an end, and what that means for themselves as well as their loved ones. Levels of this anxiety can range from mild to extreme.
Cognitive symptoms with mild anxiety include the patient being hyper alert or having difficulty concentrating. This can escalate to being totally out of focus and unable to distract. Emotional symptoms include irritability, tearfulness or excessive worry. The physical symptoms of anxiety in the dying patient can result in their inability to rest or to sleep. Their heart rate may increase, breathing may be accelerated, or they may even experience nausea. Some patient’s anxiety can be so severe, that it can result in something called terminal agitation. Those who have this condition are usually very near the end of their life. They may experience physical, emotional, and spiritual restlessness.
Characteristics of Terminal Agitation include:
· Sudden changes in behavior such as outburst, anger, depression and withdrawal.
· Constant pulling at their cloths or bedsheets
· Pulling away from intimacy
· Talking about dead family members
These can be ominous signs of impending death.
It is believed that several factors can contribute to the anxiety/restlessness of the dying patient. They include, but are not limited to:
· Poorly managed pain.
· Uncontrolled shortness of breath
· Organ failure
· Medical problems such as anemia, dehydration and fever
· Lack of voluntary activity in the body such as urine retention or constipation
All hospice patients are ordered a small amount of medications to be administered on an as-needed basis. These include liquid Morphine for pain/shortness of breath and Lorazepam for anxiety.
Before, or as we medicate, we can incorporate some of these holistic, non-pharmacological interventions:
Music therapy - Research suggests that music is very beneficial for the dying patient, their loved ones, and staff. This often happens after just one session. Music is found to reduce anxiety, agitation and pain. It also helps patients take slower and deeper breaths. It can bring back pleasant memories and boost their mood. Some dementia patients have been known to remember all the lyrics of a cherished song from long ago.
Massage therapy - Touch can promote many positive changes for the dying patients. These changes include lowering blood pressure, promoting better rest and relaxation which may lead to reduced pain and anxiety. Massage also promotes a sense of peace and comfort.
Pet Therapy - Also known as animal-assisted therapy, uses the natural bond between animals and humans to provide comfort, peace, and a soothing companionship for the terminally ill patient.
Aroma Therapy - The combination of aroma therapy with massage therapy has proven to be very beneficial and increases the positive effects of reducing stress and promoting an overall sense of calm for the patient.
These alternative therapies, along with medications, are all part of the “arsenal” used to treat the most common and pervasive symptom of the dying patient — Anxiety.
It is the responsibility of the hospice caregiver to recognize and treat this symptom as quickly as possible to maintain the comfort of the dying patient. This involves perception, skill and compassion — all necessary components of a hospice care worker.