Korean J Psychosom Med.  2018 Dec;26(2):94-101. 10.22722/KJPM.2018.26.2.94.

The Changing Patterns and Predisposing Factors of Delirium at End of Life in Palliative Care Unit

Affiliations
  • 1Department of Psychiatry, Inha University Hospital, Incheon, Korea. ckgodman@hanmail.net
  • 2Department of Internal Medicine, Inha University Hospital, Incheon, Korea.

Abstract


OBJECTIVES
The purpose of this study is to investigate the change pattern and the leading factors of delirium in the palliative ward from 2 weeks before to the end of life.
METHODS
From October 2015 to August 2017, a retrospective chart review was conducted on the final 180 patients of 207 patients with terminal cancer patients at the Inha University Hospital. Clinical records were collected during palliative care hospitalization. Patients were diagnosed with three subtypes of delirium through the Richmond Agitation Sedation Scale and the Nursing Delirium Screening Scale, which were evaluated daily.
RESULTS
The prevalence of delirium 13 days before death was 46%, of which 18.3% were hyperactive subtypes, 13.8% were hypoactive subtypes, and mixed subtypes were 13.8%. And hyperactive delirium gradually decreased with the approach to the end of the day, and the mixed subtype gradually increased until 4 days before the end of life. Of the patients, the day before death, 86.9% were diagnosed with delirium. In multivariate analysis, hematologic malignancy was associated with a lower rate of delirium at the end of life than gastrointestinal cancer. Overweight was associated with hyperactive, mixed, and hypoactive delirium.
CONCLUSIONS
Most palliative care patients experienced delirium at the end of life. Overweight was considered as a protective factor that reduced the all subtypes of delirium at the end of life. Further prospective studies are needed to reveal the prevalence of terminal delirium, and their risk factors.

Keyword

Delirium; Palliative medicine; Hospice; Cancer patients; End of life

MeSH Terms

Causality*
Delirium*
Dihydroergotamine
Gastrointestinal Neoplasms
Hematologic Neoplasms
Hospices
Hospitalization
Humans
Mass Screening
Multivariate Analysis
Nursing
Overweight
Palliative Care*
Palliative Medicine
Prevalence
Prospective Studies
Protective Factors
Retrospective Studies
Risk Factors
Dihydroergotamine
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