Palliative and Supportive Care

Original Articles

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

Scott A. Irwina1a3 c1, Sanjai Raoa3a4, Kimberly A. Bowera1, Joanna Palicaa3, Sanjay S. Raoa3, Jeanne E. Maglionea3, Matt Soskinsa1, Amy E. Bettertona2 and Frank D. Ferrisa1

a1 Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California

a2 Information Technology, San Diego Hospice & Palliative Care, San Diego, California

a3 Department of Psychiatry, University of California, San Diego, La Jolla, California

a4 Department of Psychiatry, Veterans Affairs Healthcare System, La Jolla, California

ABSTRACT

Objectives: 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.

Methods: 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.

Results: 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.

(Received August 17 2007)

(Accepted August 20 2007)

Correspondence:

c1 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: sirwin@sdhospice.org