The impact on the family of terminal restlessness and its management

Brajtman, Susan

doi:10.1191/0960327103pm779oa

Cited by 71 publications

(101 citation statements)

References 39 publications

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“…Considering that Epoch 1 data indicated a mean MMSE of 1.7, it is possible that some of these residents were near death 18 months later. Various researchers have found that an increase in agitation occurs near death and may actually be a marker for near death (Allen, Burgio, Fisher, Hardin, & Shuster, 2005;Brajtman, 2003;Jones, King, Speck, Kurowsaka, & Tookman, 1998). Unfortunately, in this study we do not have data on when residents died.…”

Section: Discussionmentioning

confidence: 99%

“…HLM has the capacity to analyze information about the rate and the pattern of change in targeted variables over multiple time points, taking into account inter-and intraindividual variability in change and cross-level interactions of time with predictors (Raudenbush & Bryk, 2002;Singer, 1998;Snijders & Bosker, 1999). We conducted HLM analyses separately for staff ratings and direct observation of agitation using the PROC MIXED procedure in SAS for Windows 9.1 (SAS Institute, 2002/2003. We examined main effects (i.e., factors that predict variability in baseline agitation) and cross-level interactions (i.e., interaction between predictors and time effect).…”

Section: Analysesmentioning

confidence: 99%

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A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

et al. 2007

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Purpose: Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. Design and Methods: The study included participants (N = 78) from a larger study who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. We recorded agitation using two measures: (a) the computer-assisted behavioral observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. We used longitudinal hierarchical linear modeling to capture the dynamic nature of behavior change as a function of individual resident characteristics and time. Results: The profoundly cognitively impaired residents (M Mini-Mental State Examination [MMSE] score = 1.7) displayed more agitation than the moderately impaired group (M MMSE score = 15.4) at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. Implications: With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and we present an alternative measure that may help to avoid these difficulties.

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Section: Discussionmentioning

confidence: 99%

Section: Analysesmentioning

confidence: 99%

A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

et al. 2007

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“…Delirium increases distress for family members (11,12), especially at the end of life where communication is impaired (73,74,78). In M A N U S C R I P T…”

Section: Pharmacological Intervention With a More Sedating Approach Omentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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“…8 In the last days or hours of life, hyperactive delirium symptoms-commonly referred to as "terminal agitation" or "terminal restlessness"-cause distress for family members. [9][10][11] Core symptoms for a Diagnostic and Statistical Manual (DSM), Fourth Edition (DSM-IV) diagnosis of delirium include disturbed consciousness, with reduced ability to focus, sustain, or shift attention; altered cognition or a perceptual disturbance, acute onset and fluctuating symptoms, which can be mild and fleeting or severe and persistent; and evidence of an etiological cause. 12 Level of consciousness identifies the three delirium subtypes: hyperactive, hypoactive, or mixed.…”

Section: Introductionmentioning

confidence: 99%

Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review

et al. 2012

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Background: Delirium is a serious neuropsychiatric syndrome frequently experienced by palliative care inpatients. This syndrome is under-recognized by clinicians. While screening increases recognition, it is not a routine practice. Aim and design: This systematic review aims to examine methods, quality, and results of delirium prevalence and incidence studies in palliative care inpatient populations and discuss implications for delirium screening. Data sources: A systematic search of the literature identified prospective studies reporting on delirium prevalence and/or incidence in inpatient palliative care adult populations from 1980 to 2012. Papers not in English or those reporting the occurrence of symptoms not specifically identified as delirium were excluded. Results: Of the eight included studies, the majority (98.9%) involved participants (1079) with advanced cancer. Eight different screening and assessment tools were used. Delirium incidence ranged from 3% to 45%, while delirium prevalence varied, with a range of: 13.3%-42.3% at admission, 26%-62% during admission, and increasing to 58.8%-88% in the weeks or hours preceding death. Studies that used the Diagnostic and Statistical Manual-Fourth Edition reported higher prevalence (42%-88%) and incidence (40.2%-45%), while incidence rates were higher in studies that screened participants at least daily (32.8%-45%). Hypoactive delirium was the most prevalent delirium subtype (68%-86% of cases). Conclusion: The prevalence and incidence of delirium in palliative care inpatient settings supports the need for screening. However, there is limited consensus on assessment measures or knowledge of implications of delirium screening for inpatients and families. Further research is required to develop standardized methods of delirium screening, assessment, and management that are acceptable to inpatients and families.Palliative Medicine 27(6) 486 -498

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The impact on the family of terminal restlessness and its management

Cited by 71 publications

References 39 publications

A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review

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