Delirium is a disturbance of attention, perception, thinking, and awareness that occurs in up to a third of people who are hospitalized, and over three fourths of those at the end of life. Delirious patients are often too confused and disoriented to have meaningful conversations with loved ones or with medical staff.The main features of delirium are:• Onset over hours to days, with a fluctuating course • Easy distraction; trouble paying attention to a conversation • Jumbled or disorganized thoughts and speech • Changing level of consciousness, from very drowsy to overly alert Other common features are:• Disturbed sleep-wake cycle (up all night, sleep all day) • Mood changes (e.g., tearful, irritable, agitated, apathetic) • Seeing or hearing things that are not there, or misperceiving events • Impaired memory • Short periods of clear thinking (so-called "lucid intervals") Delirium has many possible causes but is reversible only about half the time, even when potential causes are corrected. Most often, delirium at the end of life is a troublesome symptom that must be managed with orientation aids and medications.
Orientation aids include:• Keeping eyeglasses, hearing aids, and dentures in use during the day • Keeping a calendar, nightlight, and familiar objects or people clearly visible • Encouraging activity during the day (e.g., up in a chair, conversation, singing) • Having a sleep routine with minimal disturbances at night Medications include:• Neuroleptics (e.g., haloperidol, olanzepine, quetiapine) for disturbed thinking and perception • Sedatives (e.g., lorazepam, phenobarbital) for agitation. Delirium in the last few days of life can require aggressive sedation for patient comfort and safety.The information and recommendations appearing on this page are appropriate in most instances, but are not a substitute for medical diagnosis. For specific information concerning your personal situation or medical condition, JPM suggests that you consult your physician. This
