The incidence and prevalence of delirium across palliative care settings: A systematic review

Abstract

Background: Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. Aim: Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. Design: This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. Data sources: Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. Results: Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( n = 34) and mixed diagnoses ( n = 8) were represented. Delirium point prevalence estimates were 4%–12% in the community, 9%–57% across hospital palliative care consultative services, and 6%–74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( n = 8) was 42%–88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29–0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. Conclusion: Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.

Clinical characteristics and treatment of delirium in palliative care settings

“…Unlike the ICD-11, the DSM-5 also makes the distinction between hyperactive, hypoactive and mixed delirium [11]. While hyperactive and mixed subtypes are more precisely and easily identified due to excessive psychomotor activity, hypoactive delirium is often overlooked, although it may be predominant in palliative care with approximately 40% of delirium patients [1].…”

“No thanks, I don’t want to see snakes again”: A qualitative study of pain management versus preservation of cognition in palliative care patients

“…An earlier systematic review of the cognitive effects of opioids in cancer reported an association between opioid use and poorer performance on neuropsychological testing, albeit of uncertain clinical signi cance 15 . Delirium is a distressing cognitive disturbance that occurs frequently in the palliative care population; a systematic review reported a delirium point prevalence of 35% on admission to an inpatient palliative care unit and a prevalence ranging up to 88% in the last hours to days before death 46 . One inpatient hospice study reported a prevalence rate of 9.8% for subsyndromal delirium, which may manifest as cognitive impairment without necessarily meeting the full criteria for a delirium diagnosis 47 .…”

Delirium screening practice in specialist palliative care units: a survey

“…[1] Patients in specialist palliative care units (SPCUs) are at increased risk of delirium. [2] Approximately one third of patients have delirium on admission and 58-88% in the weeks or days preceding death. [2] Delirium is distressing for the patient, their family, friends and healthcare staff, [3] and reduces patients' ability to communicate.…”

“…[2] Approximately one third of patients have delirium on admission and 58-88% in the weeks or days preceding death. [2] Delirium is distressing for the patient, their family, friends and healthcare staff, [3] and reduces patients' ability to communicate. [4] Fluctuating symptoms need regular, systematic assessment of delirium, [5] which is rarely implemented.…”