Journal article
Predisposing and precipitating risk factors for delirium in palliative care patients.
- Seiler A Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- Schubert M University of Applied Science, School of Health Professions, Zurich, Switzerland.
- Hertler C Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.
- Schettle M Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.
- Blum D Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.
- Guckenberger M Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland.
- Weller M Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- Ernst J Center of Clinical Nursing Science, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- von Känel R Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- Boettger S Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
- 2019-11-15
Published in:
- Palliative & supportive care. - 2020
Delirium
Palliative care patients
Palliative treatment
Precipitating factors
Predisposing factors
Risk factors
English
OBJECTIVE
Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse.
METHOD
In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients.
RESULTS
The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069-0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918-37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251-3.841; p < 0.01), frailty (OR 15.28; CI 5.885-39.665; p < 0.001), hearing (OR 3.52; CI 1.721-7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765-5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033-12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062-43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102-12.149; p < 0.05).
SIGNIFICANCE OF RESULTS
Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.
Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse.
METHOD
In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients.
RESULTS
The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069-0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918-37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251-3.841; p < 0.01), frailty (OR 15.28; CI 5.885-39.665; p < 0.001), hearing (OR 3.52; CI 1.721-7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765-5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033-12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062-43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102-12.149; p < 0.05).
SIGNIFICANCE OF RESULTS
Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1017/S1478951519000919
- PMID 31722766
- Persistent URL
- https://folia.unifr.ch/global/documents/230182
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