Anxiety at the End of Life: How to Spot It and Treat It


It’s very common for those in the last stages of life to suffer from anxiety—in fact, research shows that almost 20 percent of people who are terminally ill experience it. This is normal, as they are going through something they have never encountered before. But while some anxiety is expected, and is in fact healthy, severe anxiety can be crippling.

Terminally ill patients who struggle with anxiety have less trust in their medical providers, are less likely to ask questions about their health, and have more trouble processing their medical information, according to research. That’s why it’s so important to watch for anxiety in your loved one, and react quickly to it.

Why anxiety happens

There are many reasons why someone dying experiences anxiety. They include:

  • Troubling symptoms. Shortness of breath or severe pain are common causes of anxiety.
  • Fear of dying. They may be afraid that they will die alone, or that they will suffer and be in pain, or that there is no afterlife. It’s the unknown, which can be scary.
  • Family conflicts. An unsupportive spouse or angry children can trigger anxiety, according to a report published in the Journal of the American Osteopathic Association. This can be made even worse if the family is already under financial stress because of the illness—for example, the person dying is the breadwinner.
  • Worry about who will take care of the family, both financially and emotionally, once they are gone.
  • They simply feel alone, as if no one around them understands. They may be unwilling to talk to family or close friends about their feelings, or they try to but those closest to them don’t “get it.”

Warning signs

Mild anxiety, such as being irritable, is par for the course for someone grappling with their mortality. You should be concerned if you see any of the symptoms below, if they are not typical for your loved one or their condition. (People with dementia, for example, may regularly experience difficulty concentrating or trouble sleeping at night.)

  • Panic attacks. These can include heart palpitations, sweating, trembling or shaking, and feeling like they are being smothered or choked. They may tell you that they are worried about suffocating to death.
  • Uncontrollable crying or extreme anger
  • Extreme difficulty concentrating, even at times seeming completely disconnected from the current situation (for example, you’re talking to your loved one, and they seem so distracted they’re not listening or following directions)
  • Trouble sleeping at night; lying awake feeling restless and anxious

How to treat end-of-life anxiety

If you notice any of the above signs, your loved one’s physician or hospice provider. Anxiety in patients at the end of life hasn’t been studied very much, and as a result there’s no good research on how well drugs work to treat this condition. That said, here are some drugs your doctor or hospice nurse may suggest to help:

  • Opioids may be used to help treat symptoms that are contributing to anxiety, such as trouble breathing or pain. They may also relax a patient.
  • Anti-anxiety medications such as lorazepam (Ativan), alprazolam (Xanax), or diazepam (Valium).
  • Anti-depressant medications such as sertraline (Zoloft) or fluoxetine (Prozac) if your loved one has more than a few weeks left to live. Since these drugs can initially make anxiety worse, they may be given with an anti-anxiety medication.

There are also other therapies and strategies that can help. These include:

  • Massage therapy, which research shows can help relieve anxiety in people receiving palliative or hospice care.
  • Music therapy. Just a single session has been shown to improve anxiety.
  • Meditation or guided imagery. One University of Washington review of these mind/body techniques found that they may significantly reduce anxiety and emotional distress.
  • Putting aside conflict. Any family discord that’s still festering needs to be put to rest immediately. Knowing that loved ones are getting along and supportive of one another can go a long way towards alleviating anxiety. Key words you should all be saying to each other include: “I forgive you,” “Forgive me,“ “Thank you,” “I love you,” and “Goodbye.”
  • Counseling. Sometimes it helps for your loved one to spend some time talking to someone who isn’t a family member and who is specifically trained to address this type of situation—like a hospice social worker or psychologist. One type of therapy, called cognitive behavior therapy (CBT), where patients are actually taught to change their thought patterns and responses, has been shown to quickly improve symptoms of anxiety in hospice patients.
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