Delirium at the end of life

Overview

Delirium is defined as a non-specific, global cerebral dysfunction with concurrent disturbances of consciousness, attention, thinking, perception, memory, psychomotor behaviour, emotion, and the sleep–wake cycle.[1] In assessing clinical research, there is some difficulty in that the terms "delirium" and "cognitive failure" are at times used interchangeably. Cognitive failure encompasses both delirium (which is common in people with advanced disease in the last weeks of life) and dementia, and amnesic disorders (which are relatively rare in this population).[2] This systematic review covers only people with delirium secondary to underlying terminal illness, who are being treated in the palliative care setting. For the purposes of this review, we have used the NICE definition of supportive care as follows: supportive care "helps the patient and their family to cope with cancer and treatment of it — from prediagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and into bereavement. It helps the patient to maximise the benefits of treatment and to live as well as possible with the effects of the disease. It is given equal priority alongside diagnosis and treatment."[3] This definition was written in relation to people with cancer, but is applicable to all people with terminal illness. We have used the WHO definition of palliative care as follows: "Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."[4] Although this definition of palliative care does not specify incurable or terminal illness, there is consensus that palliative care applies to people approaching the end of life: that is, people with prognosis of less than 1 year. Thus, both supportive and palliative care embrace the same priorities of maximising quality of life, but supportive care aims to do this in people who may live longer, become cured, or who are in remission from their disease.

Latest citations

Drug cessation in complex older adults: time for action. (06 December 2013)

Delirium screening in critically ill patients: A systematic review and meta-analysis. (29 January 2013)