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Psychiatric issues in palliative care: Recognition of delirium in patients enrolled in hospice care

  • Scott A. Irwin (a1) (a2), Sanjai Rao (a2) (a3), Kimberly A. Bower (a1), Joanna Palica (a2), Sanjay S. Rao (a2), Jeanne E. Maglione (a2), Matt Soskins (a1), Amy E. Betterton (a4) and Frank D. Ferris (a1)
  • DOI:
  • Published online: 01 May 2008

Delirium is prevalent, difficult to assess, under-recognized, and undertreated in hospice and palliative care settings. Furthermore, it is associated with significant morbidity and mortality. Under-recognition of delirium results in under-treatment and increased suffering. The intent of this study was to retrospectively evaluate the recognition of delirium in a large cohort of hospice patients by interdisciplinary hospice care teams.


A retrospective chart review of 2,716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of delirium in patients with advanced, life-threatening illnesses by front-line hospice clinicians. Documentation of “delirium” as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team.


Of the patients receiving home/long-term care, 17.8% (386/2168) had delirium documented as a diagnosis or significant problem. The presence of recognized delirium in this setting was associated with significant differences in marital status, ethnicity, hospice diagnosis, and age. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 28.3% (614/548) had delirium documented as a diagnosis or significant problem. Recognized delirium in this setting was associated with significant differences in gender, ethnicity, hospice diagnosis, and length of inpatient stay.

Significance of results:

If documentation is representative of the care that the interdisciplinary teams provide, delirium of any kind appears to be under-recognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved delirium assessment is needed in order to minimize the impact of delirium on patients living with advanced, life-threatening illnesses and their caregivers.

Corresponding author
Address correspondence and reprint requests to: Scott A. Irwin, M.D., Medical Director, Palliative Care Psychiatry, San Diego Hospice & Palliative Care, 4311 3rd Ave., San Diego, CA 92103. E-mail:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

W. Breitbart , E. Bruera , H. Chochinov & M. Lynch (1995). Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. Journal of Pain Symptom Manage,

W. Breitbart & D. Strout (2000). Delirium in the terminally ill. Clinical Geriatric Medicine, 16, 357372.

E. Bruera , L. Miller , J. McCallion , K. Macmillan , L. Krefting & J. Hanson (1992). Cognitive failure in patients with terminal cancer: A prospective study. Journal of Pain Symptom Manage, 7, 192195.

G. Bucht , Y. Gustafson , & O. Sandberg (1999). Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders, 10, 315318.

G.L. Carter , A.H. Dawson , & R. Lopert (1996). Drug-induced delirium. Incidence, management and prevention. Drug Safety, 15, 291301.

C. Centeno , A. Sanz , & E. Bruera (2004). Delirium in advanced cancer patients. Palliative Medicine, 18, 184194.

J.L. Cobb , M.J. Glantz , P.K. Nicholas , E.W. Martin , A. Paul-Simon , B.F. Cole , & I.B. Corless (2000). Delirium in patients with cancer at the end of life. Cancer Practice, 8, 172177.

M.G. Cole (2004). Delirium in elderly patients. American Journal of Geriatric Psychiatry, 12, 721.

F. Fernandez , J.K. Levy , & P.W. Mansell (1989). Management of delirium in terminally ill AIDS patients. International Journal of Psychiatry in Medicine, 19, 165172.

S.K. Inouye (1994). The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. American Journal of Medicine, 97, 278288.

S.K. Inouye , ST. Bogardus Jr, P.A. Charpentier , L Leo-Summers , D. Acampora , T.R. Holford , & L.M. Cooney Jr (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 340, 669676.

S.K. Inouye , ST. Bogardus Jr, C.S. Williams , L. Leo-Summers & J.V. Agostini (2003). The role of adherence on the effectiveness of nonpharmacologic interventions: Evidence from the delirium prevention trial. Achieve of Internal Medicine, 163, 958964.

K.C. Jackson & A.G. Lipman (2004). Drug therapy for delirium in terminally ill patients. Cochrane Database System Review, CD004770.

J.H. Jose Pereira & E. Bruera (1997). The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer, 79, 835842.

K.A. Kehl (2004). Treatment of terminal restlessness: A review of the evidence. Journal of Pain and Palliative Care Pharmacotherapy, 18, 530.

D.L. Leslie , Y. Zhang , S.T. Bogardus , (2005). Consequences of preventing delirium in hospitalized older adults on nursing home costs. Journal of the American Geriatric Society, 53, 405409.

P.G. Lawlor , B. Gagnon , l.L. Mancini , J.L. Pereira , J. Hanson , M.E. Suarez-Almazor & E.D. Bruera (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Achieve of Internal Medicine, 160, 786794.

W.M. Plonk Jr & R.M. Arnold (2005). Terminal care: The last weeks of life. Journal of Palliative Medicine, 8, 10421054.

P.T. Trzepacz (1996). Delirium. Advances in diagnosis, pathophysiology, and treatment. Psychiatric Clinics of North America, 19, 429448.

J.B. Weber , J.H. Coverdale , & M.E. Kunik (2004). Delirium: Current trends in prevention and treatment. Internal Medicine Journal, 34, 115121.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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