Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

Abstract

Objectives: The aim of this study was to assess the prevalence of delirium, using the Assessment Test for Delirium and Cognitive Impairment (4AT) in end-of-life palliative care patients. Subjects and Methods: This retrospective cross-sectional study was conducted in a sample of end-of-life palliative care patients in a hospice or at home. All patients were evaluated with the 4AT for the presence of delirium. Results: Of the 461 patients analyzed, 16.5% (76) were inpatients and 83.5% (385) outpatients. The median age of the whole sample was 79.5 (72-86) years and 51.0% were female. According to the 4AT score 126 patients (27.3%) had delirium (A4T ≥4) at admission, 28 (36.8%) were inpatients and 98 (25.5%) outpatients. Our sample included cancer and non-cancer life-limiting diseases and represents the whole palliative care and end-of-life population of general adult palliative care services in Italy. One third of cancer inpatients (23, 33.8%) had delirium and two third (45, 66.2%) did not. Among cancer outpatients 69 (20.6%) had delirium and 266 (79.4%) did not have. The prevalence of delirium varied according to the setting, clinical condition and life expectancy. According to the 4AT score, 33.8% (23) cancer inpatients and 20.6% (69) outpatients were with delirium. In addition, 55.0% (11) actively dying inpatients, within three days, had delirium and 56.7% (17) outpatients; while among those with life expectancy longer than 4 days, 30.4% (17) inpatients and 22.8% (81) outpatient were with delirium. Conclusions: Our study confirms that delirium is common in cancer and non-cancer palliative care patients. . Further research on delirium in end-of-life palliative care patients should consider the complexity of palliative care of this population as well as of the setting’s characteristics.