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KMID : 0607520180260020094
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Korean Journal of Psychosomatic Medicine
2018 Volume.26 No. 2 p.94 ~ p.101
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The Changing Patterns and Predisposing Factors of Delirium at End of Life in Palliative Care Unit
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Rim Mi-Roo
Kang Sang-Gu
Choi Seo-Hyeon
Cho Jin-Hyun
Lee Moon-Hee
Kim Hye-Young
Bae Jae-Nam
Lee Jung-Sub
Kim Won-Hyung
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Abstract
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Objectives：The purpose of this study is to investigate the change pattern and the leading factors of delirium in the palliative ward from 2 weeks before to the end of life.
Methods：From October 2015 to August 2017, a retrospective chart review was conducted on the final 180 patients of 207 patients with terminal cancer patients at the Inha University Hospital. Clinical records were collected during palliative care hospitalization. Patients were diagnosed with three subtypes of delirium through the Richmond Agitation Sedation Scale and the Nursing Delirium Screening Scale, which were evaluated daily.
Results：The prevalence of delirium 13 days before death was 46%, of which 18.3% were hyperactive subtypes, 13.8% were hypoactive subtypes, and mixed subtypes were 13.8%. And hyperactive delirium gradually decreased with the approach to the end of the day, and the mixed subtype gradually increased until 4 days before the end of life. Of the patients, the day before death, 86.9% were diagnosed with delirium. In multivariate analysis, hematologic malignancy was associated with a lower rate of delirium at the end of life than gastrointestinal cancer. Overweight was associated with hyperactive, mixed, and hypoactive delirium.
Conclusions：Most palliative care patients experienced delirium at the end of life. Overweight was considered as a protective factor that reduced the all subtypes of delirium at the end of life. Further prospective studies are needed to reveal the prevalence of terminal delirium, and their risk factors.
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KEYWORD
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Delirium, Palliative medicine, Hospice, Cancer patients, End of life
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