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Psychiatric issues in palliative care: Recognition of delirium in patients enrolled in hospice care

Published online by Cambridge University Press:  23 May 2008

Scott A. Irwin ,
Sanjai Rao ,
Kimberly A. Bower ,
Joanna Palica ,
Sanjay S. Rao ,
Jeanne E. Maglione ,
Matt Soskins ,
Amy E. Betterton  and
Frank D. Ferris
Scott A. Irwin*
Affiliation:
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California Department of Psychiatry, University of California, San Diego, La Jolla, California
Sanjai Rao
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California Department of Psychiatry, Veterans Affairs Healthcare System, La Jolla, California
Kimberly A. Bower
Affiliation:
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California
Joanna Palica
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California
Sanjay S. Rao
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California
Jeanne E. Maglione
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, California
Matt Soskins
Affiliation:
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California
Amy E. Betterton
Affiliation:
Information Technology, San Diego Hospice & Palliative Care, San Diego, California
Frank D. Ferris
Affiliation:
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California
*
Address correspondence and reprint requests to: Scott A. Irwin, M.D., Medical Director, Palliative Care Psychiatry, San Diego Hospice & Palliative Care, 4311 3rd Ave., San Diego, CA 92103. E-mail: [email protected]
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Abstract

Objectives:

Delirium is prevalent, difficult to assess, under-recognized, and undertreated in hospice and palliative care settings. Furthermore, it is associated with significant morbidity and mortality. Under-recognition of delirium results in under-treatment and increased suffering. The intent of this study was to retrospectively evaluate the recognition of delirium in a large cohort of hospice patients by interdisciplinary hospice care teams.

Methods:

A retrospective chart review of 2,716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of delirium in patients with advanced, life-threatening illnesses by front-line hospice clinicians. Documentation of “delirium” as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team.

Results:

Of the patients receiving home/long-term care, 17.8% (386/2168) had delirium documented as a diagnosis or significant problem. The presence of recognized delirium in this setting was associated with significant differences in marital status, ethnicity, hospice diagnosis, and age. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 28.3% (614/548) had delirium documented as a diagnosis or significant problem. Recognized delirium in this setting was associated with significant differences in gender, ethnicity, hospice diagnosis, and length of inpatient stay.

Significance of results:

If documentation is representative of the care that the interdisciplinary teams provide, delirium of any kind appears to be under-recognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved delirium assessment is needed in order to minimize the impact of delirium on patients living with advanced, life-threatening illnesses and their caregivers.

Keywords

DeliriumPalliative careEnd of lifeHospiceAssessment
Type
Original Articles
Information
Palliative & Supportive Care , Volume 6 , Issue 2 , June 2008 , pp. 159 - 164
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Breitbart, W., Bruera, E., Chochinov, H. & Lynch, M. (1995). Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. Journal of Pain Symptom Manage,CrossRefGoogle ScholarPubMed
Breitbart, W., Marotta, R., Platt, M.M., Weisman, H., Derevenco, M., Grau, C., Corbera, K., Raymond, S., Lund, S. & Jacobson, P. (1996). A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. American Journal of Psychiatry, 153, 231–237.Google ScholarPubMed
Breitbart, W. & Cohen, K. (2000). Delirium in the terminally ill. In Handbook of psychiatry in palliative medicine Chochinov, H. M. & Breitbart, W. (eds.), 435. New York: Oxford University Press.Google Scholar
Breitbart, W. & Strout, D. (2000). Delirium in the terminally ill. Clinical Geriatric Medicine, 16, 357–372.CrossRefGoogle ScholarPubMed
Bross, M.H. & Tatum, N.O. (1994). Delirium in the elderly patient. American Family Physician, 50, 1325–1332.Google ScholarPubMed
Bruera, E., Miller, L., McCallion, J., Macmillan, K., Krefting, L. & Hanson, J. (1992). Cognitive failure in patients with terminal cancer: A prospective study. Journal of Pain Symptom Manage, 7, 192–195.CrossRefGoogle ScholarPubMed
Bucht, G., Gustafson, Y., & Sandberg, O. (1999). Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders, 10, 315–318.CrossRefGoogle ScholarPubMed
Carter, G.L., Dawson, A.H., & Lopert, R. (1996). Drug-induced delirium. Incidence, management and prevention. Drug Safety, 15, 291–301.CrossRefGoogle ScholarPubMed
Centeno, C., Sanz, A., & Bruera, E. (2004). Delirium in advanced cancer patients. Palliative Medicine, 18, 184–194.CrossRefGoogle ScholarPubMed
Cobb, J.L., Glantz, M.J., Nicholas, P.K., Martin, E.W., Paul-Simon, A., Cole, B.F., & Corless, I.B. (2000). Delirium in patients with cancer at the end of life. Cancer Practice, 8, 172–177.CrossRefGoogle ScholarPubMed
Cole, M.G. (2004). Delirium in elderly patients. American Journal of Geriatric Psychiatry, 12, 7–21.CrossRefGoogle ScholarPubMed
Conn, D.K. & Lieff, S. (2001). Diagnosing and managing delirium in the elderly. Canadian Family Physician, 47, 101–108.Google ScholarPubMed
Fernandez, F., Levy, J.K., & Mansell, P.W. (1989). Management of delirium in terminally ill AIDS patients. International Journal of Psychiatry in Medicine, 19, 165–172.CrossRefGoogle ScholarPubMed
Gustafson, Y., Lundstrom, M., Bucht, G., et al. (2002). [Delirium in old age can be prevented and treated]. Tidsskr Nor Laegeforen, 122, 810–814.Google ScholarPubMed
Hepp, U. (2002). [Diagnosis and treatment of delirium]. Schweiz Rundsch Med Prax, 91, 455–463.Google ScholarPubMed
Inouye, S.K. (1994). The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. American Journal of Medicine, 97, 278–288.CrossRefGoogle ScholarPubMed
Inouye, S.K., Bogardus, ST. Jr, Charpentier, P.A., Leo-Summers, L, Acampora, D., Holford, T.R., & Cooney, L.M. Jr (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 340, 669–676.CrossRefGoogle ScholarPubMed
Inouye, S.K., Bogardus, ST. Jr, Williams, C.S., Leo-Summers, L. & Agostini, J.V. (2003). The role of adherence on the effectiveness of nonpharmacologic interventions: Evidence from the delirium prevention trial. Achieve of Internal Medicine, 163, 958–964.CrossRefGoogle ScholarPubMed
Jackson, K.C. & Lipman, A.G. (2004). Drug therapy for delirium in terminally ill patients. Cochrane Database System Review, CD004770.CrossRefGoogle ScholarPubMed
Jose Pereira, J.H. & Bruera, E. (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer, 79, 835–842.3.0.CO;2-#>CrossRefGoogle Scholar
Kehl, K.A. (2004). Treatment of terminal restlessness: A review of the evidence. Journal of Pain and Palliative Care Pharmacotherapy, 18, 5–30.Google ScholarPubMed
Leslie, D.L., Zhang, Y., Bogardus, S.T., et al. (2005). Consequences of preventing delirium in hospitalized older adults on nursing home costs. Journal of the American Geriatric Society, 53, 405–409.CrossRefGoogle ScholarPubMed
Lawlor, P.G., Gagnon, B., Mancini, l.L., Pereira, J.L., Hanson, J., Suarez-Almazor, M.E. & Bruera, E.D. (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Achieve of Internal Medicine, 160, 786–794.CrossRefGoogle ScholarPubMed
Massie, M.J., Holland, J. & Glass, E. (1983). Delirium in terminally ill cancer patients. American Journal of Psychiatry, 140, 1048–1050.Google ScholarPubMed
Medicare. (1983). Hospice care—HCFA. Final rule. Federal Registry 48, 56008–56036.Google Scholar
Pancrazi, M.P. & Metais, P. (2003). [Delirious states in elderly persons. Clinical characteristics]. Presse Med, 32, 742–749.Google ScholarPubMed
Plonk, W.M. Jr & Arnold, R.M. (2005). Terminal care: The last weeks of life. Journal of Palliative Medicine, 8, 1042–1054.CrossRefGoogle ScholarPubMed
St Pierre, J. (1996). Delirium in hospitalized elderly patients: Off track. Critical Care Nursing Clinics of North America, 8, 53–60.CrossRefGoogle ScholarPubMed
Stiefel, F. & Holland, J. (1991). Delirium in cancer patients. International Psychogeriatrics, 3, 333–336.CrossRefGoogle ScholarPubMed
Trzepacz, P.T. (1996). Delirium. Advances in diagnosis, pathophysiology, and treatment. Psychiatric Clinics of North America, 19, 429–448.CrossRefGoogle Scholar
Weber, J.B., Coverdale, J.H., & Kunik, M.E. (2004). Delirium: Current trends in prevention and treatment. Internal Medicine Journal, 34, 115–121.CrossRefGoogle ScholarPubMed
Woo, S.K. (1988). The psychiatric and neuropsychiatric aspects of HIV disease. Journal of Palliative Care, 4, 50–53.CrossRefGoogle ScholarPubMed