The occurrence and timing of delirium in acute care hospitalizations in the last year of life: A population-based retrospective cohort study

Abstract

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

The prevalence, associated factors, clinical impact, and state of diagnosis of delirium in palliative care patients

“…Such patients should still be promptly treated for their delirium symptoms, and they might need palliative sedation in cases of refractory agitated delirium [35,36]. Interestingly, in contrast to most of the previous studies [18,19,26,30], we found that psychoactive medications were not associated with delirium. This may be because our study recruited only newly referred palliative care patients, for whom the median morphine equivalent daily dose was only 11.25 mg.…”

“…Our research also found that the prevalence of delirium increased as death approached, with 88.9% of patients being delirious on their last few days of life. Other studies have similarly reported that terminal delirium occurred in 88-93% of patients [2,18,26]. This remarkably high prevalence rate underscores the need for discussions to be conducted as early as possible about the goals of care, advance care planning, and the need to take care of unfinished business.…”

Red blood cell transfusion and associated outcomes in patients referred for palliative care: A retrospective cohort study

“…The databases within ICES capture vital status and socioeconomic status based on median household income of neighborhood by postal code; physician contact, and interventions through billing codes; acute care admission diagnoses, comorbidities, interventions, measures of multimorbidity using admissions data from acute care hospitals across Ontario; and emergency visits. The presence of 18 chronic conditions (comorbidities) were determined using previously described and employed algorithms 15–17 …”

“…The presence of 18 chronic conditions (comorbidities) were determined using previously described and employed algorithms. [15][16][17]…”

Anticoagulant use and associated outcomes in older patients receiving home palliative care: a retrospective cohort study

“…37 We determined diagnoses of cancer, congestive heart failure, chronic obstructive pulmonary disease, dementia, diabetes mellitus, hypertension and renal disease using previously developed algorithms that use diagnosis codes and drug-dispensing data to ascertain these conditions. [38][39][40] Finally, we obtained physician demographics and practice characteristics from the ICES Physician Database and the Corporate Provider Database. 29,41 A detailed description of the databases and the specific codes can be found in Appendix 1, Supplemental Tables 1 and 2.…”