Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Guo, Dabin; Deng, Chuanyao; Zheng, Yu; Gao, Langli; Yue, Jirong

doi:10.3389/fpsyt.2021.772387

Cited by 8 publications

(7 citation statements)

References 52 publications

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“…[73, 74] A less hydrated state may contribute to delirium through several processes, such as cerebral and renal hypoperfusion, increased concentration of medications and renal impairment. [75, 76]…”

Section: Discussionmentioning

confidence: 99%

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

Nwosu,

Stanley,

Mayland

et al. 2023

Preprint

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Background Oral fluid intake decreases in people with advanced cancer, especially when they approach the dying phase of their illness. There is inadequate evidence to support hydration assessment and decision making in the dying phase of illness. Bioelectrical impedance analysis (BIA) and vector analysis (BIVA) are validated methods of hydration assessment, with research demonstrating that hydration status is associated with specific symptoms, and survival in advanced cancer. However, further research is needed to better understand the relationships between hydration status and clinical outcomes in advanced cancer, particularly at the end-of-life. Aim To evaluate hydration status and its associations with clinical outcomes in advanced cancer patients, and those in the last week of life. Materials and methods An observational study of people with advanced cancer in three centres. Advance consent methodology was used to conduct hydration assessments in the dying. Total body water was estimated using the BIA Impedance index (Height, H (m)2 /Resistance, R (Ohms)). We used backward regression to identify factors (signs, symptoms, quality of life) that predict H2/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes. Results 125 people participated (males n=74 (59.2%), females, n=51 (40.8%). BIVA demonstrated that baseline hydration status was normal in 58 (46.4%), more-hydrated in 52 (41.6%) and less hydrated in 13 (10.4%). Regression analysis demonstrated that less hydration (lower H2/R) was associated with female sex (Beta = -0.371, p<0.001), increased anxiety (Beta = -0.135, <0.001), increased severity of physical signs (dry mouth, dry axilla, sunken eyes - Beta = -0.204, p<0.001), and increased breathlessness (Beta = -0.180, p<0.014). More hydration (higher H2/R) was associated with oedema (Beta= 0.514, p<0.001) and increased pain (Beta = 0.156, p=0.039). Eighteen participants (14.4%) were in the last week of life. For dying participants, hydration status (H2/R) was not significantly different compared to baseline (n= 18, M= 49.55, SD= 16.00 vs. M= 50.96, SD= 12.13; t(17)= 0.636, p = 0.53) and was not significantly associated with agitation (rs = -0.847, p = 0.740), pain (rs = 0.306, p = 0.232) or respiratory tract secretions (rs = -0.338, p = 0.185). Conclusions In advanced cancer, hydration status was associated with specific physical signs and symptoms. No significant associations between survival and hydration status were recorded. In the dying phase, hydration status did not significantly change compared to baseline, and was not associated with symptoms. Further work can use BIA/BIVA to standardise the process to identify clinically relevant outcomes for hydration studies, to establish aa core outcome set to evaluate how hydration affects symptoms and quality of life in cancer.

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Section: Discussionmentioning

confidence: 99%

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

Nwosu,

Stanley,

Mayland

et al. 2023

Preprint

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“…This was decided from a clinical point of view to be more accurate in using preventive measures and further screening instruments. The four items on the RSL‐4 have previously been identified as most predisposing factors for developing delirium (Guo et al, 2021 ; Zipser et al, 2021 ). Scoring the RSL‐4 could decrease the time spend on further screening for delirium, since we suggest to not use the DOS for patients identified as low risk.…”

Section: Discussionmentioning

confidence: 99%

“…Several predisposing and precipitating factors exist for developing delirium, such as being older than 70 years of age, having pre‐existing cognitive disorders, or (withdrawal of) alcohol or opioids (American Psychiatric Association, 2013 ; Featherstone et al, 2022 ; Guo et al, 2021 ). A variety of screening tools to identify symptoms of delirium are available (Watt et al, 2021 ), such as the Delirium Observation Screening (DOS) Scale (Neefjes et al, 2019 ; Schuurmans et al, 2003 ).…”

Section: Introductionmentioning

confidence: 99%

A simple risk score list can be used to predict the occurrence of delirium in patients admitted to inpatient hospice care: A medical record study

Stoevelaar

Juffermans

Roorda

et al. 2022

European J Cancer Care

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Objective This study aimed to examine whether the 10‐item Risk Score List (RSL) accurately predicts delirium in patients admitted to inpatient hospice care and whether this instrument can be simplified. Determining the risk for developing delirium can help to treat these patients in a timely manner. Methods This was a retrospective medical record study in patients who died in 2019 or 2020 in three hospices. Predictive values were examined using Cox regression analysis, crosstabs, and C‐statistic. Results In total, 240 patients were included. Median age at admission was 78 (IQR 70–84) years. Primary diagnosis most often was cancer (n = 186, 78%); 173 (72%) patients had an increased risk of delirium according to RSL, of whom 120 (69%) developed delirium. Overall, 147 (61%) patients developed delirium. The RSL significantly predicted future delirium (HR 3.25, CI 1.87–5.65, p < 0.01) and had a sensitivity of 85%, a specificity of 43%, positive predictive value of 62%, negative predictive value of 73%, and a C‐statistic of 0.64. Simplifying the RSL to four items still significantly predicted future delirium, with similar predictive values. Conclusion Delirium occurs in more than half of patients admitted to hospice care. The RSL can be simplified to four items, without compromising on predictive accuracy.

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“…In terminally-ill people, delirium syndrome usually involves multifactorial causes. The most recent evidence from prospective observational studies, systematic reviews and meta-analysis studies report risk factors for terminal delirium to include older age, male sex, organ failure, fluid and electrolyte imbalances, dehydration, suboptimal pain management, hypoxia, breathlessness, poor well-being with declining performance status, and medication adverse effects (Bush et al, 2014; Corli et al, 2021; Ellsworth et al, 2021; Guo et al, 2021). Delirium care poses a significant challenge in EOL care, causing significant distress for the dying person and families, as it is often under-diagnosed or undetected.…”

Section: Clinical Signs and Symptoms That Show Eol Is Imminent In Ind...mentioning

confidence: 99%

A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness

Ijaopo

Zaw

Ijaopo

et al. 2023

Gerontology and Geriatric Medicine

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Background: World population is not only aging but suffering from serious chronic illnesses, requiring an increasing need for end-of-life care. However, studies show that many healthcare providers involved in the care of dying patients sometimes express challenges in knowing when to stop non-beneficial investigations and futile treatments that tend to prolong undue suffering for the dying person. Objective: To evaluate the clinical signs and symptoms that show end-of-life is imminent in individuals with advanced illness. Design: Narrative review. Methods: Computerized databases, including PubMed, Embase, Medline,CINAHL, PsycInfo, and Google Scholar were searched from 1992 to 2022 for relevant original papers written in or translated into English language that investigated clinical signs and symptoms of imminent death in individuals with advanced illness. Results: 185 articles identified were carefully reviewed and only those that met the inclusion criteria were included for review. Conclusion: While it is often difficult to predict the timing of death, the ability of healthcare providers to recognize the clinical signs and symptoms of imminent death in terminally-ill individuals may lead to earlier anticipation of care needs and better planning to provide care that is tailored to individual’s needs, and ultimately results in better end-of-life care, as well as a better bereavement adjustment experience for the families.

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Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 52 publications

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

A simple risk score list can be used to predict the occurrence of delirium in patients admitted to inpatient hospice care: A medical record study

A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness

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