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Delirium in oncological palliative care and clinical cardiology units: A comparative analysis

Published online by Cambridge University Press:  27 July 2022

Elisa Sánchez Grisales ,
Ana María Higuita ,
Marcela Escobar Correa ,
John Jairo Vargas Gómez ,
Carolina Palacio González Open the ORCID record for Carolina Palacio González [Opens in a new window] ,
Alicia Krikorian Daveloza  and
José Gabriel Franco Vásquez
Elisa Sánchez Grisales
Affiliation:
School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
Ana María Higuita
Affiliation:
Pyschology Unit, Clínica Las Américas, Medellín, Colombia
Marcela Escobar Correa
Affiliation:
Pyschology Unit, Clínica Las Américas, Medellín, Colombia
John Jairo Vargas Gómez
Affiliation:
Pyschology Unit, Instituto de Cancerología, Clínica Las Américas, Medellín, Colombia
Carolina Palacio González
Affiliation:
Universidad Pontificia Bolivariana and Pyschology Unit, Instituto de Cancerología, Medellín, Colombia
Alicia Krikorian Daveloza
Affiliation:
School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
José Gabriel Franco Vásquez
Affiliation:
Liaison Psychiatry Research Group, School of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
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Abstract

Objective

The aim of this study was to compare the sociodemographic and clinical characteristics of delirium in patients treated in a clinical cardiology unit (CCU) and an oncological palliative care unit (OPCU) at a high-complexity institution.

Context

Delirium is a neuropsychiatric syndrome with multicausal etiology, associated with increased morbidity and mortality.

Method

This was a cross-sectional, analytical observational study. CCU and OPCU patients were evaluated for 480 days. The diagnosis was made according to DSM-V. Sociodemographic characteristics, the Karnofsky index, and the Charlson index were evaluated. Possible etiologies were verified. Severity was assessed with the Delirium Severity Scale (DRS-R98).

Results

A total of 1,986 patients were evaluated, 205 were eligible, and 110 were included in the study (CCU: 61, OPCU: 49). Delirium prevalence was 11.35% in the CCU and 9.87% in the OPCU. CCU patients were 12 years older (p < 0.03) and a history of dementia (41 vs. 8.2%; p < 0.001). Organ failure was the most frequent etiology of delirium in the CCU (41.0%), and in the OPCU, the etiologies were neoplasms (28.6%), side effect of medication (22.4%), and infections (2.5%). Differences were found in the clinical characteristics of delirium evaluated by DRS-R98, with the condition being more severe and with a higher frequency of psychotic symptoms in OPCU patients.

Conclusion

Delirium was a common condition in hospitalized patients in the CCU and the OPCU. The clinical characteristics were similar in both groups; however, significant differences were found in OPCU patients in terms of age, personal history of dementia, and opioid use, as well as the severity of delirium and a greater association with psychotic symptoms. These findings have implications for the early implementation of diagnostic and therapeutic strategies.

Keywords

CardiologyDeliriumDementiaOncological palliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 5 , October 2023 , pp. 805 - 811
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

REFERENCES

Barnes, J, Kite, S and Kumar, M (2010) The recognition and documentation of delirium in hospital palliative care inpatients. Palliative & Supportive Care 8(2), 133–136.CrossRefGoogle ScholarPubMed
Bush, SH, Leonard, MM, Agar, M, et al. (2014) End-of-life delirium: Issues regarding recognition, optimal management, and the role of sedation in the dying phase. Journal of Pain and Symptom Management 48(2), 215–230.CrossRefGoogle ScholarPubMed
Bush, SH, Tierney, S and Lawlor, PG (2017) Clinical assessment and management of delirium in the palliative care setting. Drugs 77(15), 1623–1643.CrossRefGoogle ScholarPubMed
Bush, SH, Lawlor, PG, Ryan, K, et al. (2018) Delirium in adult cancer patients: ESMO clinical practice guidelines. Annals of Oncology 29, iv143–iv165.CrossRefGoogle ScholarPubMed
Caraceni, A (2013) Drug-associated delirium in cancer patients. EJC Supplements 11(2), 233.CrossRefGoogle ScholarPubMed
Cole, JL (2020) Steroid-induced sleep disturbance and delirium: A focused review for critically ILL patients. Federal Practitioner 37(6), 260.CrossRefGoogle ScholarPubMed
de la Cruz, M, Fan, J, Yennu, S, et al. (2015) The frequency of missed delirium in patients referred to palliative care in a comprehensive cancer center. Supportive Care in Cancer 23(8), 2427–2433.CrossRefGoogle Scholar
Delgado-Guay, MO, Ferrer, J, Ochoa, J, et al. (2018) Characteristics and outcomes of advanced cancer patients who received palliative care at a public hospital compared with those at a comprehensive cancer center. Journal of Palliative Medicine 21(5), 678–685.CrossRefGoogle Scholar
Douglas, IJ and Smeeth, L (2008) Exposure to antipsychotics and risk of stroke: Self controlled case series study. BMJ 337, a1227.CrossRefGoogle ScholarPubMed
Falsini, G, Grotti, S, Porto, I, et al. (2018) Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: A prospective study (DELIRIUM CORDIS). European Heart Journal: Acute Cardiovascular Care 7(7), 661–670.Google ScholarPubMed
Fonseca, F, Bulbena, A, Navarrete, R, et al. (2005) Spanish version of the delirium rating scale-revised-98: Reliability and validity. Journal of Psychosomatic Research 59(3), 147–151.CrossRefGoogle ScholarPubMed
Franco, JG, Mejía, MA, Ochoa, SB, et al. (2007) Delirium rating scale-revised-98 (DRS-R-98): Colombian adaptation of the spanish version. Actas Espanolas de Psiquiatria 35(3), 170–175.Google ScholarPubMed
Gaudreau, JD, Gagnon, P, Harel, F, et al. (2005) Psychoactive medications and risk of delirium in hospitalized cancer patients. Journal of Clinical Oncology 23(27), 6712–6718.CrossRefGoogle ScholarPubMed
Gaviria, LMV (2016) Instrumentos para el diagnóstico de delirium en hispanohablantes: Artículo de revisión. Medicina UPB 35(2), 100–110.CrossRefGoogle Scholar
Grotti, S and Falsini, G (2017) Delirium in cardiac patients. European Heart Journal 38(29), 2244–2244.CrossRefGoogle ScholarPubMed
Hshieh, TT, Inouye, SK and Oh, ES (2020) Delirium in the elderly. Clinics in Geriatric Medicine 36(2), 183–199.CrossRefGoogle ScholarPubMed
Inouye, SK (2006) Delirium in older persons. New England Journal of Medicine 354(11), 1157–1165.CrossRefGoogle ScholarPubMed
Inouye, SK, Westendorp, RG and Saczynski, JS (2014) Delirium in elderly people. The Lancet 383(9920), 911–922.CrossRefGoogle ScholarPubMed
Lahariya, S, Grover, S, Bagga, S, et al. (2014) Delirium in patients admitted to a cardiac intensive care unit with cardiac emergencies in a developing country: Incidence, prevalence, risk factor and outcome. General Hospital Psychiatry 36(2), 156–164.CrossRefGoogle Scholar
Lawlor, PG (2002) The panorama of opioid-related cognitive dysfunction in patients with cancer: A critical literature appraisal. Cancer 94(6), 1836–1853.CrossRefGoogle Scholar
Lawlor, PG and Bush, SH (2015) Delirium in patients with cancer: Assessment, impact, mechanisms and management. Nature Reviews Clinical Oncology 12(2), 77–92.CrossRefGoogle ScholarPubMed
Lawlor, PG, Gagnon, B, Mancini, IL, et al. (2000) Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine 160(6), 786–794.CrossRefGoogle ScholarPubMed
Marchena-Gomez, J, Acosta-Merida, MA, Hemmersbach-Miller, M, et al. (2009) The age-adjusted charlson comorbidity Index as an outcome predictor of patients with acute mesenteric ischemia. Annals of Vascular Surgery 23(4), 458–464.CrossRefGoogle ScholarPubMed
Matsuoka, H, Yoshiuchi, K, Koyama, A, et al. (2015) Chemotherapeutic drugs that penetrate the blood–brain barrier affect the development of hyperactive delirium in cancer patients. Palliative & Supportive Care 13(4), 859–864.CrossRefGoogle ScholarPubMed
Mishra, S (2016) Does modern medicine increase life-expectancy: Quest for the moon rabbit? Indian Heart Journal 68(1), 19–27.CrossRefGoogle ScholarPubMed
Morita, T, Tei, Y, Tsunoda, J, et al. (2001) Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. Journal of Pain and Symptom Management 22(6), 997–1006.CrossRefGoogle ScholarPubMed
Morrison, RS, Magaziner, J, Gilbert, M, et al. (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58(1), M76–M81.CrossRefGoogle ScholarPubMed
Naghavi, M, Abajobir, AA, Abbafati, C, et al. (2016) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study. The Lancet 390(10100), 1151–1210.CrossRefGoogle Scholar
Noh, G, Kwon, I, Lee, M, et al. (2018) Factor analysis of delirium in elderly, using the Korean version of delirium rating scale-revised-98. Psychiatry Investigation 15(5), 484.CrossRefGoogle ScholarPubMed
Nydahl, P, Baumgarte, F, Berg, D, et al. (2022) Delirium on stroke units: A prospective, multicentric quality-improvement project. Journal of Neurology 269(7), 3735–3744.CrossRefGoogle ScholarPubMed
Pauley, E, Lishmanov, A, Schumann, S, et al. (2015) Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. American Heart Journal 170(1), 79–86.CrossRefGoogle ScholarPubMed
Pendlebury, ST, Lovett, NG, Smith, SC, et al. (2015) Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: Age-specific rates and associated factors, mortality and re-admission. BMJ Open 5(11), e007808.CrossRefGoogle ScholarPubMed
Restrepo, D, Duque, M, Montoya, L, et al. (2018) Risk factors and hospital mortality in surgical and non-surgical patients with delirium. Revista Colombiana de Psiquiatría (English Ed.) 47(3), 148–154.CrossRefGoogle ScholarPubMed
Sato, K, Kubota, K, Oda, H, et al. (2017) The impact of delirium on outcomes in acute, non-intubated cardiac patients. European Heart Journal: Acute Cardiovascular Care 6(6), 553–559.Google ScholarPubMed
Schag, CC, Heinrich, RL and Ganz, PA (1984) Karnofsky performance status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology 2(3), 187–193.CrossRefGoogle ScholarPubMed
Şenel, G, Uysal, N, Oguz, G, et al. (2017) Delirium frequency and risk factors among patients with cancer in palliative care unit. American Journal of Hospice and Palliative Medicine 34(3), 282–286.CrossRefGoogle ScholarPubMed
Tomé, AM and Filipe, A (2011) Quinolones. Drug Safety 34(6), 465–488.CrossRefGoogle ScholarPubMed
Uchida, M, Okuyama, T, Ito, Y, et al. (2015) Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: A longitudinal observational study. Japanese Journal of Clinical Oncology 45(10), 934–940.CrossRefGoogle Scholar
Van Den Beuken-Van, MH, Hochstenbach, LM, Joosten, EA, et al. (2016) Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. Journal of Pain and Symptom Management 51(6), 1070–1090.CrossRefGoogle Scholar
Webber, C, Watt, CL, Bush, SH, et al. (2021) Hospitalization outcomes of delirium in patients admitted to acute care hospitals in their last year of life: A population-based retrospective cohort study. Journal of Pain and Symptom Management 61(6), 1118–1126.CrossRefGoogle ScholarPubMed