As individuals approach the end of life, caregivers may observe behaviors that are distressing or confusing, such as the patient attempting to remove their clothing. This action is rarely intentional or disrespectful. Instead, it often stems from complex underlying physiological and neurological processes. Understanding these medical reasons can help caregivers respond with empathy and provide appropriate comfort during this challenging time.
Physiological Changes
The human body maintains a stable internal temperature through thermoregulation. As a person nears death, this intricate system can malfunction, leading to a sensation of being overheated, even if their actual core body temperature is not significantly elevated. This can result in what feels like a “hot flash” or a fever, prompting the patient to shed clothing in an attempt to find relief.
Metabolic changes also contribute to these sensations. The body’s energy production slows down as organs begin to shut down, which might surprisingly lead to a perceived increase in warmth as circulation patterns shift. Although the body’s overall temperature may decrease in the final hours, fluctuating temperatures are common, and localized feelings of heat can occur due to impaired blood flow regulation. This can cause the patient to feel an urgent need to remove perceived constrictions like clothing to cool down.
Altered Mental States
Neurological and cognitive changes are frequently observed in dying patients, significantly influencing their behavior. Delirium, a state of acute confusion, can manifest as disorientation, agitation, and a diminished awareness of surroundings. Patients experiencing delirium may not recognize where they are, who is present, or understand social conventions, leading them to disrobe without conscious intent. This condition can fluctuate, with periods of lucidity interspersed with confusion.
Brain hypoxia, a reduction in oxygen supply to the brain, is a common contributor to altered mental states. As the circulatory system weakens, the brain receives less oxygen, impairing cognitive function and leading to confusion, disorientation, and sometimes hallucinations. Metabolic imbalances, such as electrolyte disturbances or the buildup of toxins from failing organs, can also induce encephalopathy that causes agitation and changes in behavior, including disrobing.
General Discomfort and Restlessness
Beyond specific physiological and neurological changes, dying patients may experience a broad range of physical discomforts and general restlessness that can lead to removing clothes. This generalized agitation, sometimes referred to as “terminal restlessness” or “terminal agitation,” can manifest as an urge to move, fidget, or attempt to remove anything that feels restrictive. The patient may pick at bedding or clothing, or try to get out of bed, indicating an underlying unease.
Various forms of pain, itching, or pressure from bedding or clothing can trigger this behavior. Patients might attempt to alleviate these sensations by disrobing, even if the direct cause is not immediately visible to observers. The act of removing clothes is often an instinctive effort to find a position or state of greater comfort, reflecting their internal distress rather than a deliberate action.