We all know someone who experienced this situation. A person begins to worsen health until reaching a point of no return, confirmed by the medical team. The family begins to assume that they are facing last hours of your loved one.
However, suddenly, the patient experiences an episode of luciditya resurgence that makes everyone believe in an inexplicable recovery. He talks to those close to him, recognizes his family and shows a strange normality that no one can explain. Unfortunately, when everything pointed to a more favorable prognosis, the patient faded to the end.
A little studied phenomenon
This phenomenon, which does not even have an established scientific name, is known as terminal lucidity. Dr. Anna Renom, geriatrician of the Hospital del Mar and secretary of the board of the Catalan Society of Geriatrics and Gerontology of the Academy of Medical Sciences of Catalonia, accompanies elderly people in his last moments. Before attending this interview, he shared experiences and knowledge with a group of colleagues, including palliative care specialists.
“It is a very little studied topic, although professionals also have the perception that this phenomenon exists«, admits Renom.
“I remember a patient who, approaching the end of her life, had an episode of lucidity the day before. He seemed more awarehe was able to talk better with his family and doctors. Shortly afterward he worsened again and died the next day or a little later.”
Although the scientific community validate the existence of terminal lucidity due to various investigations, it has not been possible to establish a clear definition or confirm its causes.
Dr. Renom acknowledges that this episode may be disconcerting to professionals who are not used to seeing it, but she assures that diagnostic tools confirm that the prognosis does not change. “Palliative care specialists observe it frequently and, although resurgence usually coincides with imminent deathare not always related. «We cannot affirm that when this episode happens, the person will die in a matter of hours or days,»* he clarifies. «There is not enough evidence to say for sure.»
There are families waiting for this moment
When a patient is in the final phase of your lifesome families ask that sedation not be administered, since they have heard about this phenomenon and fear that the medication will prevent a last conversation or goodbye. “A palliative colleague came across cases in which it is the patient himself who does not want to be sedated so as not to lose the possibility of living this moment,” adds Dr. Renom.
How do doctors manage it? Renom insists that, given a sudden improvementprofessionals cannot assure families that it is time to say goodbye because there is no scientific evidence to support such a recommendation. “What we must do is validate what is happening.
If a family member comments that the patient seems especially lucid, we advise them to take the opportunity to talk to him, because could be momentary. We cannot ignore this phenomenonalthough we do not have in-depth knowledge about it,» explains the doctor. «Of course, always with great caution, because there is no certainty about what will happen next.»
Hypotheses about terminal lucidity
One of the few investigations carried out to date focused exclusively on patients with dementia. «This study literally indicates that the underlying neurobiological mechanism is unknown. In other words, it is not known what triggers this resurgence,» says Dr. Renom.
One of the most mentioned hypotheses, although not confirmed, suggests that extreme stress What the body suffers in the last hours of life causes massive release of adrenaline and other hormones. These substances could generate a state of lucidity in the body’s last attempt to cling to life. However, this remains just a theory without conclusive evidence.
The phenomenon has more studies in patients with dementia, a framework in which some researchers call it “paradoxical lucidityThe term “terminal” has been avoided because it does not always precede the immediate death of the patient.
These episodes of improvement in the ability to interact and connection with the environment They happen spontaneously and unexpectedly, even in people who had completely lost this ability. They were observed in patients with dementia, brain diseases and advanced tumors.
However, a precise definition is still missing so as not to confuse it with other processes. «What is confirmed is that 90% of patients with severe dementia what experienced this episode died within seven days”, points out Renom.
In conclusion, professionals agree that this phenomenon—already be it mental or physical— exists and is frequent in certain patients. However, the lack of knowledge is so extensive that it is not possible to establish a specific action protocol. In the face of uncertainty, doctors usually recommend that families take advantage of these moments, since it is not known how long they can last or if they will happen again.
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