Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
DOI:
https://doi.org/10.24950/rspmi.1752Keywords:
Delírium, Palliative CareAbstract
Introduction: Delirium is one of the most frequent complications in palliative care with a prevalence as high as 88% in the days preceding the end-of-life. Data on delirium home-based palliative care are scarce. The aim of this work is to characterize the population followed by a palliative care team, both in-hospital and at home, to assess the prevalence of delirium, the therapeutic strategy, its resolution, and the factors associated with the higher or lower prevalence of delirium.
Methods: A retrospective cohort study was carried out,
including all patients followed in the hospital and at home by a
palliative care team in Portugal during the year of 2019.
Results: A total of 496 patients were included, of whom 308 (62.1%) had in-hospital follow-ups. Delirium was identified in 112 (22.6%) of all patients and the first line drug used was haloperidol (51.8%). A total of 283 (57.1%) patients died, of whom 81 (28.6%) developed delirium. The occurrence of death was significantly higher in those who developed delirium (72.3%, p <0.001). Associated with higher incidence of delirium were identified in-hospital follow-up (27.9%, p <0.001), infection (53.9%, p <0.001), endocrine (84.6%, p <0.001) and ionic changes (55.0%, p <0.001), use of anticholinergics (54.1%, p = 0.001), antipsychotics (42.6%, p = 0.031), corticosteroids (37.7%, p = 0.008), and presence of brain metastasis (50.0%, p = 0.046).
Conclusion: There is a significant prevalence of delirium in end-of-life patients, which is a predictor of poor prognosis. The implementation of quality palliative care with a multidisciplinary approach may provide more effective control of delirium and reduce its overall prevalence.
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