End-of-life dreams and visions can heal the mind even when the body cannot be healed. Hospice care workers as well as researchers have learned that dreams and visions are very important during the last weeks and days of life.
Why should we care? Because most of us will experience these dreams when we approach the end of life. Understanding them can comfort and support us and those around us.
End-of-life dreams are not dementia. About 10% of people experience dementia at some point in their lives, typically when they are very old or very sick. For that reason, when an old person reports having waking visions or unusual dreams, their doctor may consider those as symptoms of dementia and not pay attention to the content of those dreams. Moreover, Hospice care has traditionally focused on pain relief and emotional or spiritual support. Often the dreams or visions reported by the patients are viewed more as a symptom of their condition, rather than pointing a path to palliative treatment.
A team of medical doctors, nurses and psychologists is hoping to change these attitudes, as described in two recent research articles by authors at Hospice Buffalo (Cheektowaga, NY), Daemen College (Amherst, MA) and Canisius College (Buffalo, NY). Today’s blog summarizes their work and discusses its implications for our personal lives.
End-of-Life Dreams versus Near-Death Experiences
End-of-life dreams and visions should not be confused with near-death experiences, which are quite different.
End-of-life dreams, by definition, are ended by the patient’s death; near-death experiences, on the other hand, are reported by patients who did not die, who report the events after surviving a serious injury or illness.
There are some similarities between end-of-life dreams and near-death experiences. In both cases, we often find:
– A theme of taking a trip or crossing a boundary
– Positive emotions
– Visions of deceased loved ones
– Dream content that is influenced by the person’s culture and beliefs
– Less commonly (less than 20% of the time), an uncomfortable or even terrifying experience.
Despite these similarities, there are distinct differences between end-of-life dreams and near-death experiences. Certainly, the surrounding circumstances are not the same. In addition, near-death experiences are rare (because very few people come that close to death and still recover), while end-of-life dreams occur in more than half of conscious dying patients.
Near-death experiences are also set apart because they often include features that are uncommon in end-of-life dreams:
– The feeling of entering a tunnel
– Seeing a powerful light
– Life review: “seeing one’s life flash before one’s eyes”
– A sense of being dead
– Feeling detached from one’s physical body.
Seeing “angels,” figures dressed in white or religious figures are often reported as part of near-death experiences. These religious or quasi-religious images are relatively rare in end-of-life dreams of Americans. (This is one factor that seems to be culturally dependent: patients from India more frequently report seeing religious figures.)
End-of-Life Dreams: Frequency and Content
The Buffalo study interviewed 66 patient volunteers at Hospice Buffalo during an 18-month period ending in mid-2012. The average age of the participants was 75. Seven were omitted from the final results: six were still alive, and one had provided only one interview, well before death.
The research team estimated the health status of the patients using the Palliative Performance Scale, a zero-to-100% classification system developed by Victoria Hospice. The patients selected for the study all had a PPS score of 40% or less, meaning that they were expected to survive only 8 to 18 days, were mostly bedbound, had extensive disease, needed assistance with most or all Activities of Daily Living and had reduced or minimal food intake. In other words, these were people who were expected to pass very soon. The PPS assessment is pretty accurate: 60 of the 66 participants died during the study, an average of 21.6 days (median 15 days) after their first interview.
The researchers interviewed each patient daily, so long as the patient continued to be responsive. 52 of the 59 participants reported at least one dream or vision, in a total of 269 reports. This 88% of positive responses seems very high compared with people in general: sleep researchers estimate that 95% of all dreams are forgotten shortly after waking up and that less than half of people recall dreams more than once or twice a month.
When we refer to end-of-life dreams and visions we are including both experiences during sleep (dreams) and while awake (visions). In this group, 45% reported only dreams, 16% only visions, and 39% reported both dreams and visions. In nearly all instances, participants said that the experience felt “real.” This is different from most near-death experiences: in those cases, the event feels not at all ordinary.
The content of the end-of-life dreams and visions was quite consistent:
– 46% featured deceased friends or relatives
– 17% had living friends or relatives
– 10% had other people
– 35% had a variety of other content: deceased pets or animals, living pets or animals, religious figures, past meaningful experiences, and miscellaneous content.
In addition, 39% of reports by the patients featured a theme of going somewhere, or preparing to go somewhere, an obvious allusion to an imminent passing.
End-of-Life Dreams: Meaning to the Dreamer
End-of-life dreams are rarely neutral in their emotional content. 60% are seen as comforting, 19% as distressing, and only 21% as neutral in meaning. Dreams and visions involving deceased relatives, friends or pets were particularly comforting; this type of dream begins 6 weeks before death and becomes more and more frequent until passing. The authors note with interest that the dead persons appearing in the dreams usually did not speak, yet their presence conveyed reassurance to the dreamer.
The patients who have these end-of-life dreams tend to be clearly conscious and aware of their surroundings. The researchers state that these dreams and visions “differ most from hallucinations or delirium by the responses they evoke, including inner peace, acceptance, and the sense of impending death.”
End-of-Life Dreams: Comfort for the Survivor
Family and friends who visit a patient in hospice care naturally hope that the patient’s final days are free of pain and of mental distress. End-of-life dreams and visions have a role to play in the comfort level of both a deceased person and their survivors.
A lot depends on how the professional caregivers respond. If a healthcare worker considers these dreams and visions as delirium, without significance, his reaction devalues them for the patient and does nothing to allay the alarm that visitors may feel.
These research studies, however, point us toward another path. Caregivers can now recognize that end-of-life dreams and visions are a predictable feature of the end of life: a source of reconciliation, reassurance and closure to the patient. With this knowledge, health workers can advise family members that the visions are normal, meaningful and comforting to their loved one. That it is valuable to listen to the patient describe the dreams and be accepting, so that the dying person does not feel isolated and shut off.
End-of-life dreams can allow caregivers to facilitate communication between patients and family members, leading to inclusion and acceptance for the patient, and reassurance and comfort for the family.
End-of-Life Dreams: Importance for Caregivers
The Buffalo researchers are well aware of the implications of their work in clinical settings. They note that patients, families and physicians are reluctant to discuss end-of-life dreams and visions: the lay persons fear ridicule, and the professionals doubt their medical legitimacy. In fact, patients themselves hesitate to bring up the subject, except sometimes to nurses.
The Buffalo studies demonstrate that discussing end-of-life dreams deserves to be part of standard protocol for hospice settings, a key ingredient in providing emotional and psychological support to the patient. As the researchers say,
…families and practitioners should engage in conversations about the dreams and visions to further promote this sense of comfort as well as to validate the experiences. End-of-life experiences are part of a healing process that should not be ignored by the health care personnel. …discussion about dreams and visions allows patients to share and presents a therapeutic opportunity for the clinicians to assist patient[s] and their families in the transition from life to death.
End-of-Life Dreams as Human Adaptation
End-of-life dreams are a nice example of a natural phenomenon that’s not easy to explain via evolution. After all, even though a person who is about to die gains comfort from these experiences, having these visions does not help him pass along his genes to the next generation.
As a scientist, I see several plausible explanations for such dreams:
– Those who see a grand design in human life, as a matter of religious or philosophical faith, can see end-of-life dreams as an appropriate, even necessary part of that design;
– Those who stand in awe of the brain’s amazing complexity may consider end-of-life dreams as a hard-to-comprehend natural function of this incredible organ: studies of dying mice seem to point in this direction; or
– End-of-life dreams may have survival value for the species by comforting the patient’s relatives, who are the primary caregivers in many human societies: these dreams could give them the courage to persevere through life’s struggles and sustain the human race.
Do you know relatives or friends who described end-of-life dreams or visions prior to their death? How did they seem to feel about the experience?
Kerr et al, End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ Experiences
Nosek et al, End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients
Drawing Credits: (all on openclipart.org)
– “Alien Brain Reader” by j4p4n
– “imagine” by presquesage
– “Old-mans-Face” by StefanvonHalenbach
– “Nurse” by chlopaya