As patients approach the end of life, they may experience intense end of life dreams and visions of people or events from their past. Recent research suggests these experiences are worldwide phenomena that are largely beneficial but can be challenging to understand, both for patients and their families.1
But what exactly are these visions before death? What do they mean, and where do they come from? Perhaps most importantly, what hospice support for families and patients can help them better navigate this phenomenon?
Visions Before Death: What do They Mean?
Also known as end-of-life experiences (ELEs), visions and dreams before death are common among patients. In fact, a recent study found that 63.3 percent of patients reported an ELE, and 78.9 percent were able to recall these experiences “vividly and in detail.”2
Common among these visions before death were visits from deceased relatives, vivid memories from patients’ past, or dreams about travel, and more than 60 percent of patients found them comforting. As they came closer to the end of life — from months to weeks or days — the frequency of their ELEs increased and the content changed, with many patients reporting interactions with deceased loved ones.
As noted by hospice physician Christopher Kerr, who has spent more than 20 years talking to hospice patients about their end-of-life experiences, dying comes with a decline in physical capacity, but it seems to correlate with an increase in spiritual growth. Visions and dreams often see patients gaining insight about themselves and their life choices even as they approach their final days.3
Where do End of Life Dreams and Visions Come From?
While illness types and symptoms are different across patients, there are two points of commonality: Changes in eating and sleeping patterns. Patients who are close to death often find themselves uninterested in eating, even as their body moves more easily in an out of sleep states. Visions before death may therefore be a form of lucid dreaming, which exists somewhere between sleep and wakefulness.4 Patients experiencing these visions often say they don’t typically dream, and say they were awake, not asleep when they occurred.
For patients, these end of life dreams and visions may present a challenge: While they perceived themselves as awake and therefore undergoing a real experience, many worry that talking about their ELEs to family members or hospice staff may prompt discussions of declining cognitive function or confusion.
How Hospices Can Support Patients and Their Families
When it comes to offering support for patients and their families regarding ELEs, hospice staff can start by normalizing the process and communicating that these dreams and visions are nothing out of the ordinary — in fact, for many people they provide a sense of peace and clarity.
Hospice caregivers can also engage patients in conversation about their ELEs and what they experience. Rather than attempting to debate the “reality” of these experiences, it’s worth giving patients time and space to process these visions in their own way. If family members are willing and able to be present, so much the better; since many of these dreams are about deceased relatives or childhood memories, discussions of ELEs can act as a way for families and patients to grow closer as the days grow short.
Finally, it’s worth offering to record any information patients want to share about their ELEs. This can both help staff connect with patients as they progress through the hospice death process, and provide loved ones a sense of peace that their family members experienced a measure of closure in their final days.
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1 Cambridge University Press, “End-of-Life Dreams and Visions as Perceived by Palliative Care Professionals: A Qualitative Study,” October 19, 2021.
2 National Institutes of Health (NIH), “Significance of End-of-life Dreams and Visions Experienced by the Terminally Ill in Rural and Urban India,” April 2016
3 & 4 Discover, “What a Hospice Physician Who Interviewed 1,400 Patients Can Tell Us About Dying,” May 2, 2021.