As individuals approach the end of life, caregivers may observe various behavioral changes. One phenomenon is known as “picking at sheets.” This behavior involves repetitive hand movements, as if the person is trying to grasp or smooth bed linens. It is a common observation in the dying process, and understanding its nature can help alleviate concern for those providing care.
Describing the Behavior
“Picking at sheets” involves repetitive, often seemingly purposeless, hand movements. An individual might repeatedly pluck at bedsheets, blankets, or clothing. These actions can also extend to reaching into the air, as if attempting to catch or manipulate unseen objects. The movements often appear involuntary yet can seem directed to the observer.
This behavior frequently accompanies restlessness or agitation. The person may fidget, shift position frequently, or appear unable to settle comfortably. While the actions may seem to have a goal, they usually lack a clear objective.
Common Underlying Factors
The phenomenon of picking at sheets is associated with physiological and neurological changes as the body declines. A primary factor is terminal delirium, a state of acute confusion and altered awareness that can manifest in restlessness and agitation. This condition arises from metabolic disturbances and changes in brain function as organs begin to shut down. The brain may not receive adequate oxygen or nutrients, leading to impaired cognitive processing and disorganized thoughts.
Medication side effects also contribute to this behavior. Opioid medications, often used for pain management, can induce agitation or confusion. Other drugs, such as sedatives or anticholinergics, might paradoxically cause restlessness. Dehydration, common at the end of life, can further exacerbate confusion and contribute to delirium.
Unmanaged pain or discomfort can manifest as agitation and restlessness, leading to repetitive movements as the individual attempts to alleviate distress. Fever or infection can similarly trigger delirium and increase overall body agitation. Picking at sheets is often a sign of the body’s response to profound physiological changes and discomfort.
Supporting Your Loved One
When observing this behavior, the primary goal is to provide comfort and reduce distress. Creating a calm environment can be beneficial, such as dimming lights and reducing noise. Gentle reorientation, like speaking in a soothing voice or reminding the person where they are, can sometimes help, though it may not always stop the movements. Providing soft blankets or comfortable clothing can also prevent skin irritation from repetitive picking motions.
Ensuring comfort also involves addressing potential underlying issues. While hydration may become limited at the end of life, keeping the mouth and lips moist can prevent discomfort. Medical professionals can adjust pain management strategies if pain contributes to restlessness. Simply being present, holding a hand, or offering gentle touch can provide reassurance even if the picking continues. The aim is to comfort the individual, rather than suppress the behavior itself.
When to Seek Guidance
It is appropriate to consult with healthcare professionals, such as hospice or palliative care teams, if “picking at sheets” is new or rapidly worsening. This is important if the behavior causes significant distress to the patient. Caregivers should also seek advice if unsure about managing symptoms like pain or severe agitation. Open communication with the medical team ensures comfort measures are optimized and any reversible causes are addressed.