Hypoactive delirium: assessing the extent of the problem for inpatient specialist palliative care

Abstract

Delirium is a common problem and cause of distress among patients with palliative care needs. The focus to date has been on managing the patient with agitated, hyperactive delirium, as these patients are very noticeable within the palliative care setting. This study in two parts shows that palliative care patients with agitated delirium are a minority of the total proportion of those with delirium. Part I: 100 acute admissions to a specialist palliative care unit were assessed and while 29% were found to have delirium, 86% of these had the hypoactive subtype of delirium. We also demonstrated a positive correlation between high ratings on a depression screening tool and delirium severity ratings. Part II: 8 specialist palliative care units took part in a point prevalence study of delirium over a 48-hour period. One hundred and nine patients were assessed and while 29.4% of these inpatients had delirium, 78% of them had the hypoactive subtype. Patients with hypoactive delirium may be much less noticeable or may be misdiagnosed as having depression or fatigue and the results of this study would advocate the routine use of delirium screening tools in all palliative care settings.

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

“…1,3 At the end of the search, eight studies that prospectively measured the prevalence or incidence of delirium in specialist palliative care adult inpatient settings remained (Table 1). 4,5,[35][36][37][39][40][41] These included studies which were conducted in the northern hemisphere over a 12-year period (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008).…”

“…The included studies were undertaken in patient settings described variously as hospices (n = 2), 39,41 palliative care units (n = 3), [35][36][37] acute palliative care units (n = 2), 4,40 and a combined acute palliative care unit/hospice (n = 1). 5 Where described, the purpose of the settings included symptom control, respite, rehabilitation, and/or terminal care for palliative care patients.…”

“…The majority (98.9%) of all participants (n = 1079) across these studies had advanced cancer, with some diagnoses not specified in one study. 41 Two studies included participants with other life limiting diseases: (a) immunodeficiency disorders (n = 11) 36 and (b) end-stage cardiac failure and cerebrovascular disease (n = 1). 41 Across the studies, there was equal representation of males and females, with a mean age of 66.24 years (range 62-68.7 years).…”

Nursing Practices to Detect Acute Delirium, Safeguard Patients Experiencing Acute Delirium, and Help Reduce or Eliminate Acute Delirium

“…This diversity in findings on the frequency of acute delirium may arise from it having different forms (Yang et al, 2009). Although restlessness or hyperactivity is the most common type of acute delirium, hypoactive delirium is also common (Spiller & Keen, 2006). Hypoactive delirium is often misdiagnosed as a near-death state, coma, or transient unconsciousness (Spiller & Keen, 2006).…”

“…Although restlessness or hyperactivity is the most common type of acute delirium, hypoactive delirium is also common (Spiller & Keen, 2006). Hypoactive delirium is often misdiagnosed as a near-death state, coma, or transient unconsciousness (Spiller & Keen, 2006). Dementia, senility, mood disorders, and functional psychoses are often diagnosed instead of acute delirium (Meagher, 2001).…”