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Open Access 01-12-2021 | Care | Original Article

The prevalence, associated factors, clinical impact, and state of diagnosis of delirium in palliative care patients

Authors: Watanachai Klankluang, Sasima Tongsai, Chairat Sriphirom, Arunotai Siriussawakul, Pratamaporn Chanthong, Supakarn Tayjasanant

Published in: Supportive Care in Cancer | Issue 12/2021

Abstract

Purpose

The aim of this study is to establish the prevalence, associated factors, and clinical impact of delirium in newly referred palliative care patients and the percentage of delirium diagnoses missed by primary medical teams.

Methods

Newly referred palliative care patients were evaluated and were reviewed for possible associated factors of delirium. Univariable and multivariable analysis were used to identify associated factors. Median overall survival and survival curves were analyzed. The percentage of missed diagnosis in IPD patients was identified.

Results

We included 350 palliative care patients. Nearly all patients had cancer diagnosis (96.6%). The overall prevalence of delirium was 44.0%. The independent associated factors of delirium were age ≥ 63 years (adjusted odds ratio [aOR], 7.0; 95% CI, 2.2–22.9), palliative performance scale ≤ 20% (aOR, 54.5; 95% CI, 13.1–228.0), brain metastasis (aOR, 15.6; 95% CI, 3.7–66.7), urinary tract infection (aOR, 18.8; 95% CI, 4.7–75.5), sepsis (aOR, 59.0; 95% CI, 4.4–797.8), hyponatremia (aOR, 8.8; 95% CI, 2.6–29.8), and hypercalcemia (not applicable). Interestingly, opioids and benzodiazepines were not associated with delirium. Delirious patients had significantly shorter survival (median survival 11 days). Delirium diagnoses were missed for 76.1%.

Conclusion

Nearly half of the palliative care patients had delirium, which was associated with noticeably short survivals. We identified the independent factors associated with the delirium. Despite having a remarkably high prevalence rate and being a well-known poor prognostic factor, there was still a very high rate of missed delirium diagnoses. Effective, routine, delirium screening of palliative care patients needs to be emphasized.

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Title: The prevalence, associated factors, clinical impact, and state of diagnosis of delirium in palliative care patients
Authors: Watanachai Klankluang
Sasima Tongsai
Chairat Sriphirom
Arunotai Siriussawakul
Pratamaporn Chanthong
Supakarn Tayjasanant
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Care
Hypercalcemia
Published in: Supportive Care in Cancer / Issue 12/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06367-7

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Purpose

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