Your loved one has begun to talk of vivid dreams.  Dreams that seem to excite and perhaps upset them.  

Often the dream may involve an intense vision of a family member or friend who is long since deceased hovering above their bed.   Sometimes the visions are accompanied by powerful sensory experiences.  

Some may distinctly feel the touch of their long-deceased mother’s hand, or speak excitedly about the brush of an angel’s wing.

Often the dying will report being greeted and comforted by family or friends who have passed away in years gone by. Should you speak to the doctor about hallucinations?  What if your loved one becomes agitated and says things like, I need to be on that flight!  Or if elderly, they wake up and say Mom and Dad were here.  They’re waiting for me to go with them.  Should you seek a change in medication?

There is considerable research today into what is called End of Life Dreams and Visions (ELDV’s).  Much of this research has been done in hospice settings. Some researchers say that although the dreams and visions that come near the end of a person’s life may somewhat resemble hallucinations, they are often a completely different type of occurrence. 

These dreams and visions are so widely experienced by such a great diversity of patients in so many different end of life situations, that it is more likely they are sent to assist people in their process of dying.

The kinesthetic or sensory aspects to the dreams are comforting to the dying.

In fact, researchers at the Center for Hospice and Palliative Care, Cheektowaga, New York[i], believe the purpose of these incidents is to assist the patient in accepting their transition from this world to the next.

This ease of transition is also what nurses Callanan and Kelley, authors of Final Gifts[ii], have repeatedly experienced in the dying during their careers as hospice nurses. 

Callanan and Kelley stipulate that is important to let patients interpret their own dreams. 

If you attempt to explain their dreams, even with the best of intentions, you may be projecting your own beliefs and expectations which may be disturbing to the patient.  An alternative response might be Tell me what happened?

When the dying mention anything to do with travel, like having to catch a flight or a train, or needing to find a map or passport, a probing response like, It sounds like you’re going somewhere, is an appropriate way to help the patient interpret their dream and sort out their feelings.

Sometimes the person you are caring for will just have ‘a feeling’ about when they are going to pass. 

In that case, the patient might ask that a special day, perhaps Christmas or Easter, coming up in the near future, be celebrated early. Or they may express their belief that they might not be here for some upcoming special event.

The effect of these dreams and visions is generally a positive one which assists the dying in the process of their second birthing, from this world into the next. 

It is significant that one research team studying various international and American based studies, noted that in America, religious figures are not as frequently represented in the dreams and visions of the dying as they are in other parts of the world.

For both Patient and Caregiver, the understanding of, and appropriate responses to End of Life Dreams and Visions can be of significant benefit in the peaceful and comfortable completion of a person’s earthly journey. 

Before speaking to the doctor about a change in medication, be certain that the ‘hallucinations’ your patient is having do not represent an actual, lucid awareness of being between this world and the next—a vision intended to ease their concern about the journey on which they are about to embark.

---

[i] Grant P et al (2014) The significance of end-of-life dreams and visions. Nursing Times; 110, 28: 22-24.

Authors: Pei Grant is director of research; Scott Wright and Rachel Depner are clinical research assistants; Debra Luczkiewicz is hospice physician; all at the Center for Hospice and Palliative Care, Cheektowaga, New York.

[ii]Maggie Callanan and Patricia Kelley: Final Gifts, Understanding the Special Awareness, Needs and Communications of the Dying