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Death in delirious palliative-care patients occurs irrespective of age: A prospective, observational cohort study of 229 delirious palliative-care patients

Published online by Cambridge University Press:  15 September 2020

Annina Seiler Open the ORCID record for Annina Seiler [Opens in a new window] ,
David Blum ,
Caroline Hertler ,
Markus Schettle ,
Carl Moritz Zipser ,
Leonie Bode ,
Samuel Gehrke ,
Jutta Ernst ,
Maria Schubert  and
Roland von Känel
...Show all authors
Annina Seiler*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
David Blum
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Caroline Hertler
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Markus Schettle
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Carl Moritz Zipser
Affiliation:
Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
Leonie Bode
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Samuel Gehrke
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Jutta Ernst
Affiliation:
Center of Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, University of Applied Science, Zurich, Switzerland
Roland von Känel
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Soenke Boettger
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
*
Author for correspondence: Annina Seiler, Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091Zurich, Switzerland. E-mail: annina.seiler@usz.ch
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Abstract

Objectives

Patients with terminal illness are at high risk of developing delirium, in particular, those with multiple predisposing and precipitating risk factors. Delirium in palliative care is largely under-researched, and few studies have systematically assessed key aspects of delirium in elderly, palliative-care patients.

Methods

In this prospective, observational cohort study at a tertiary care center, 229 delirious palliative-care patients stratified by age: <65 (N = 105) and ≥65 years (N = 124), were analyzed with logistic regression models to identify associations with respect to predisposing and precipitating factors.

Results

In 88% of the patients, the underlying diagnosis was cancer. Mortality rate and median time to death did not differ significantly between the two age groups. No inter-group differences were detected with respect to gender, care requirements, length of hospital stay, or medical costs. In patients ≥65 years, exclusively predisposing factors were relevant for delirium, including hearing impairment [odds ratio (OR) 3.64; confidence interval (CI) 1.90–6.99; P < 0.001], hypertension (OR 3.57; CI 1.84–6.92; P < 0.001), and chronic kidney disease (OR 4.84; CI 1.19–19.72; P = 0.028). In contrast, in patients <65 years, only precipitating factors were relevant for delirium, including cerebral edema (OR 0.02; CI 0.01–0.43; P = 0.012).

Significance of results

The results of this study demonstrate that death in delirious palliative-care patients occurs irrespective of age. The multifactorial nature and adverse outcomes of delirium across all age in these patients require clinical recognition. Potentially reversible factors should be detected early to prevent or mitigate delirium and its poor survival outcomes.

Keywords

DeliriumPalliative-care patientsPrecipitating factorsPredisposing factors
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 274 - 282
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

The article has been updated since its original publication. See https://doi.org/10.1017/S1478951521000560.

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