Emotional changes as death approaches

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Emotional changes as death approaches

Just as your body physically prepares for death, you must prepare emotionally and mentally as well.

As death approaches, you may become less interested in the outside world and the specific details of daily life, such as the date or time. You may turn more inward and be less socially involved with others. You may want only a few people to be close. This introspection may be a means of letting go and saying good-bye to everything you have known.

In the days before death, you may enter a phase of unique conscious awareness and communication that can be misinterpreted as confusion by your caregivers and loved ones. You may talk about needing to go somewhere, about “going home” or “going away.” The meaning of this communication is not known, but some people feel this talk helps you to prepare for your approaching death.

Events in the recent past may become intertwined with memories from your distant past. You may remember events from years long gone in vivid detail but not remember what happened even an hour earlier.

You may spend time thinking about people who have already died. You may talk about seeing or hearing others who have died before you. Your loved ones or caregivers may hear you conversing with a dead friend or relative.

If you are caring for a dying loved one, you may become frightened or upset by this unique communication. You may feel you need to help reorient your loved one to reality. However, denying this experience can often be upsetting and frustrating to your loved one. If this communication bothers you, talking to your loved one's doctor or hospice worker may help you better understand what is happening.

A dying loved one may become delirious, which also can be a frightening experience for everyone involved. Delirium occurs in many of those who are near the end of life. It may have a single cause, or it may result from a combination of several factors. Causes may include:¹

• Medicines, such as morphine, sedatives, and pain relievers, or taking too many medicines that interact adversely.
• Metabolic changes from a fever or dehydration.
• Metastatic disease.
• Severe depression.

Symptoms may include:

• Agitation.
• Hallucinations.
• Unconsciousness alternating with agitation.

Delirium can sometimes be prevented with alternative treatments, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

References

Citations

1. Casarett D, Inouye S (2001). Diagnosis and management of delirium at the end of life. Annals of Internal Medicine, 135(1): 32–40.

Credits

Last updated:	July 31, 2006
Author:	Sabra L. Katz-Wise
Reviewed By:	Adam Husney, MD - Family Medicine, Ira Byock, MD - Palliative Care
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman