Delirium in palliative care

Delirium can be thought of as transient brain dysfunction. It’s often accompanied by decreased consciousness and difficulty focusing on one thing at a time. Both speech and thoughts often become confused. Delirium may also involve hallucinations. A person experiencing delirium may be agitated, but sometimes they become slow and lethargic instead. The level of delirium tends to fluctuate over the course of the day and is usually at its most intense at night. Delirium usually starts suddenly and may be intense.

Delirium can be caused by many illnesses, medications, and situations. For a patient receiving palliative care, having a serious underlying illness may cause delirium in and of itself. Delirium can result from many medications, or from discontinuing or changing the dosage of medication. Other factors that may trigger delirium include being in an unfamiliar environment, having recently had surgery (postoperative delirium), pain, or a lack of sleep. In addition, problems with eyesight, hearing, or memory make it more difficult to make sense of one’s surroundings and therefore increase the risk of delirium.

Sometimes delirium is caused by an unrelated condition that can be treated, such as a urinary tract infection or some other type of infection, cerebrovascular event, heart attack, liver or kidney failure, or electrolyte imbalance. It’s important to try and determine the cause of acute delirium.

The aim is to determine and treat the cause of delirium, if possible.

Sudden delirium in a previously stable patient requires acute medical attention.

At the end of life, delirium becomes fairly common as the body’s vital functions begin to shut down and death draws closer. At this point, the most important thing is to relieve the symptoms and the discomfort caused by delirium, using non-medication methods, and if necessary, sedative medications as well.

Towards the end of life, self-management of delirium is often indirect, taking the form of support and help provided by loved ones. Self-management of delirium involves being present, creating a calm environment, making sure that the patient is safe, and asking for help, if necessary.

Delirium can be eased by providing a familiar environment with people important to the patient. Familiar personal objects or sounds may also be helpful. The presence of a clock or a calendar, or having a view to the outside, may help establish a sense of time and place. Having proper lighting is important, as is wearing glasses and hearing aids if needed. Adhering to a regular sleep-wake cycle and getting enough rest may also help.

For a bedridden patient experiencing delirium, having distinctive objects within one’s line of vision, or devices or equipment such as lines or catheters within reach, may add to the patient’s confusion. Having an organised, easily recognisable immediate environment may be helpful in calming a patient experiencing delirium.

The patient’s medication and sufficient pain management should be adhered to regularly and as prescribed.