TERMINAL AGITATION, A CAREGIVER’S NIGHTMAREMar 22nd, 2013 | By Sharon Shaw Elrod MSW EdD | Category: Senior Moments Blog
Caregiving is increasingly common among senior citizens in today’s world of ever-increasing longevity. Many of us have elderly parents or loved ones for whom some level of care is required. They may still be in their own home, and we check in on them several times a week. Or they are still at home needing daily care and attention. Or they cannot live alone any longer and for a variety of reasons do not enter a care facility; they move in with you instead. And still more of us find our parents in nursing/group/assisted living facilities.
Let’s face it. We seniors are at high risk to become caregivers to one degree or another. And many of us are ill equipped to manage caring for the elderly who manifest a variety of behaviors that confuse and perplex us.
We encountered such a behavior a few days ago. Our elderly loved one lives in our home. She became agitated about a variety of issues, all of which included her not being able to do what she wants to do anymore. Agitation and restlessness soon turned to anger, and because of some dementia, the anger included confused thinking and delusions. Her outbursts made perfect sense to her, but certainly didn’t to anyone else in the world.
How does a caregiver handle Terminal Agitation?
Help for Caregivers: Hospice and Online
Our elder is in Hospice so the first line of action was to call them to report the angry behavior. Our superb Hospice nurse reminded us we had medication available to control restlessness and anger. She also told us this is a normal part of the dying process. She said she sees it a lot, but family members typically get very concerned when this behavior surfaces. We family members don’t expect such anger, especially when it is uncharacteristic of the elder.
“Those who work with the dying know this type of restlessness or agitation almost immediately. However, the public and patient’s family may have no idea what is going on and often become quite alarmed at their loved one’s condition.” (Terminal Agitation in the Dying)
The second course of action was to head to the Internet and do a search about angry behavior in elderly who are dying. Voila! Terminal Agitation in the Dying is a paper written by hospice staff about the very experience we were encountering. This document defines the syndrome and talks about what you need to eliminate before you can be sure this is the problem. It then leads the reader through a series of questions that need to be addressed to accurately determine if this is indeed the problem. It also describes metabolic changes in dying elders due to major body system shutting down, and then talks about medication available for use to manage the symtomatic behavior.
The important piece of this that all caregivers need to remember is that managing anger is as important as managing pain in dying elders. Anger and pain are symptoms. Palliative care requires effective management of both, and medication may be the best answer.