Caring for the Dying: Delirium and Nearing Death Awareness

As someone nears the last weeks of life (particularly the last few days) they may have episodes of ‘confusion’ expressed by uncharacteristic conversation or behaviors such as talking ‘out of their head’, seeing people who aren’t really thee or ‘picking at things’. This behavior can be a true delirium, an acute confusion due to medications, infection, or dehydration, or it could be an experience called ‘Nearing Death Awareness’.

“Final Gifts”, a book written by hospice nurses Maggie Callahan and Patricia Kelley, describes ‘Nearing Death Awareness’ experiences while explaining what can be learned from them and how families can facilitate a more peaceful death for their loved one emotionally as well as spiritually. ‘Nearing Death Awareness’ experiences often reveal hidden messages communicated by the patient giving others insight into their unique needs during the dying process.  Listening carefully to the dying person enables families to understand the dying process as an individual experience thereby allowing them to offer the comfort or reassurance sought by their loved one.

In many instances, the dying person will knowingly take control over ‘when’ they will die; for example, they may wait for a relative’s return home for a final visit, a special event such as the birth of a grandchild, a graduation or child’s birthday.  Other times the dying person may be waiting for ‘permission’ from family believing they must ‘hold on’ for the family member’s well-being instead of their own.  Frequently, the person dying describes a place of beauty and serenity beyond this world and sometimes people “who have gone before” (who the dying person see waiting).  These are almost always comforting images.  These hidden messages are usually descriptions of what the dying are experiencing and/or requests for something which will make their death a more peaceful event.

The behavior found in true delirium makes no sense at all and is disruptive to the care of the dying person. Additionally, the patient often cannot be calmed with reassurance or by the presence of appropriate family members.  When the behavior exhibited is consistent with delirium then medicines are available to promote relaxation and comfort.  If it is a true delirium, the underlying cause is treated as well.

Family members may read Final Gifts to learn how to avoid responses that are frustrating – even alienating – to both the caregiver and patient.  Reading this book can help families ease their loved one and themselves as they find comfort and peace together during this final phase of life.



1. Final Gifts by Maggie Callahan, Patricia Kelley.  Bantam 1992. [Rev.8/08]