Delirium: Opportunity for Comfort in Palliative Care

Jacqueline F. Close, PhD, RN, GCNS-BC, FNGNA; Carol O. Long, PhD, RN, FPCN

Disclosures

Journal of Hospice and Palliative Nursing. 2012;14(6):386-394. 

In This Article

Abstract and Introduction

Abstract

Delirium is a very common neuropsychiatric disorder seen in the very ill and at the end of life and is distressing to patients, families, and caregivers. Although common, delirium is frequently misdiagnosed and poorly managed. Too often, patients are merely labeled as confused or agitated. This lack of recognition, assessment, and treatment can lead to poor outcomes, including functional decline, new nursing home placement, and even death. Prompt assessment, prevention, and both pharmacologic and nonpharmacologic intervention by nurses and the interdisciplinary team can significantly reduce distress, assure comfort, and maximize safety in all care settings.

Introduction

Delirium, or acute confusion, is a very common, serious, and potentially preventable neuropsychiatric disorder that may occur in the very ill and at the end of life as part of the dying process. Patients are often labeled as confused or agitated, and no further assessment or evaluation is done. Delirium frightens patients and families and also robs patients of valuable time to spend with loved ones. Patients remember their episode(s) of delirium as very distressing, and delirium is a negative experience for family members, caregivers, and professional nurses alike.[1] Delirium is associated with emotional distress, as patients with delirium are often anxious, angry, or depressed. Pain is much more difficult to treat in patients with delirium, and those with hyperactive delirium are at risk for falls and other types of injuries.[2] Delirium also interferes with the patient's ability to make choices about their care.[3] Delirium is one of the major contributors to poor health outcomes and often results in the institutionalization of older adult patients.[2]

The purpose of this article is to provide an overview of delirium, the prevalence, key features, risk factors, subtypes, pathophysiology, assessment, and evidence-based nursing interventions, both pharmacologic and nonpharmacologic. A case study illustrates the challenges and opportunities in caring for hospitalized patients with delirium who may require palliative care. While this article provides a general overview of delirium in the acute care setting, delirium can occur anywhere in the continuum of care, including the home, skilled nursing, outpatient settings, or hospice settings.

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