Clinical case · End-of-life care
Restless and breathless in her last days
An 88-year-old care-home resident with advanced dementia and heart failure is deteriorating, restless at night and breathless at rest. Recognise that she may be dying, treat what is reversible, and keep her comfortable where she wants to be.
You will learn to
- Recognise the last days of life and plan care around the person's wishes
- Manage restlessness by treating reversible causes first, then non-drug measures, then medicines in the right order
- Relieve breathlessness without unnecessary oxygen, stop medicines that no longer help, and support the family
Presentation
Step 1 of 10You are called to a care home to see an 88-year-old woman with advanced dementia and heart failure. Over the past week she has become bed-bound, sleeps most of the day and takes only sips of fluid.
For the last two nights she has been restless, calling out and picking at her sheets. Her son is at her bedside: "She always said she didn't want to go back to hospital."
References
- Li D, Yang Y, Zhang Y, et al. Guideline for Medication Management of Distressing Symptoms in Older Patients Receiving End-of-Life Palliative Care. J Evid Based Med. 2026;19(3):e70160. doi:10.1111/jebm.70160 · PubMed 42433014
- Morin L, Laroche ML, Vetrano DL, Fastbom J, Johnell K. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus. Eur J Clin Pharmacol. 2018;74(10):1333–1342. doi:10.1007/s00228-018-2507-4 · PubMed 29934849
- Van den Block L, de Nooijer K, Pautex S, et al. A European Association for Palliative Care White Paper defining an integrative palliative, geriatric, and rehabilitative approach to care and support for older people living with frailty and their family carers: a 28-country Delphi study and recommendations. EClinicalMedicine. 2025;87:103403. doi:10.1016/j.eclinm.2025.103403 · PubMed 40838200
Last updated 2026-10-21.
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