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Delirium at the end of life

Published online by Cambridge University Press:  10 September 2020

Silvana Knoepfel ,
Leonie Bode ,
Samuel Gehrke ,
Tobias Spiller ,
Simon Fuchs ,
Jutta Ernst ,
Roland von Känel  and
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window]
Silvana Knoepfel
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Leonie Bode
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Samuel Gehrke
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Tobias Spiller
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Simon Fuchs
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Jutta Ernst
Affiliation:
Center of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Roland von Känel
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
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Abstract

Background

The general in-hospital mortality and interrelationship with delirium are vastly understudied. Therefore, this study aimed to assess the rates of in-hospital mortality and terminal delirium.

Method

In this prospective cohort study of 28,860 patients from 37 services including 718 in-hospital deaths, mortality rates and prevalence of terminal delirium were determined with simple logistic regressions and their respective odds ratios (ORs).

Results

Although overall in-hospital mortality was low (2.5%), substantial variance between services became apparent: Across intensive care services the rate was 10.8% with a 5.8-fold increased risk, across medical services rates were 4.4% and 2.4-fold, whereas at the opposite end, across surgical services rates were 0.7% and 87% reduction, respectively. The highest in-hospital mortality rate occurred on the palliative care services (27.3%, OR 19.45). The general prevalence of terminal delirium was 90.7% and ranged from 83.2% to 100%. Only across intensive care services (98.1%, OR 7.48), specifically medical intensive care (98.1%, OR 7.48) and regular medical services (95.8%, OR 4.12) rates of terminal delirium were increased. In contrast, across medical services (86.4%, OR 0.32) and in particular oncology (73.9%, OR 0.25), pulmonology (72%, OR 0.31) and cardiology (63.2%, OR 0.4) rates were decreased. For the remaining services, rates of terminal delirium were the same.

Significance of results

Although in-hospital mortality was low, the interrelationship with delirium was vast: most patients were delirious at the end of life. The implications of terminal delirium merit further studies.

Keywords

Delirium at the end of lifeIn-hospital mortalityInterrelationship of delirium and deathTerminal delirium
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 268 - 273
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

REFERENCES

Agar, MR, Quinn, SJ, Crawford, GB, et al. (2016) Predictors of mortality for delirium in palliative care. Journal of Palliative Medicine 19, 1205–1209.CrossRefGoogle ScholarPubMed
Alvarez, SJ (2008) In-hospital mortality in stroke patients. Revista Española de Cardiología 61, 1007–1009.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association.Google Scholar
Bellelli, G, Morandi, A, Di Santo, SG, et al. (2016) “Delirium Day”: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Medicine 14, 106. doi:10.1186/s12916-016-0649-8.CrossRefGoogle ScholarPubMed
Benjamini, Y and Hochberg, Y (1995) Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B 57, 289–300.Google Scholar
Bergeron, N, Dubois, MJ, Dumont, M, et al. (2001) Intensive care delirium screening checklist: Evaluation of a new screening tool. Intensive Care Medicine 27, 859–864.CrossRefGoogle ScholarPubMed
Bertomeu, V, Cequier, A, Bernal, JL, et al. (2013) In-hospital mortality due to acute myocardial infarction. Relevance of type of hospital and care provided, RECALCAR study. Revista Española de Cardiología (English ed.) 66, 935–942.Google ScholarPubMed
Fartoukh, M, Khoshnood, B, Parrot, A, et al. (2012) Early prediction of in-hospital mortality of patients with hemoptysis: An approach to defining severe hemoptysis. Respiration 83, 106–114.CrossRefGoogle ScholarPubMed
Ghaferi, AA, Birkmeyer, JD and Dimick, JB (2009) Variation in hospital mortality associated with inpatient surgery. New England Journal of Medicine 361, 1368–1375.CrossRefGoogle ScholarPubMed
Grover, S and Avasthi, A (2018) Clinical practice guidelines for management of delirium in elderly. Indian Journal of Psychiatry 60, S329–S340.Google ScholarPubMed
Grover, S and Shah, R (2011) Distress due to delirium experience. General Hospital Psychiatry 33, 637–639.CrossRefGoogle ScholarPubMed
Grover, S, Ghosh, A and Ghormode, D (2015) Experience in delirium: Is it distressing? Journal of Neuropsychiatry and Clinical Neurosciences 27, 139–146.10.1176/appi.neuropsych.13110329CrossRefGoogle ScholarPubMed
Hall, MJ, Levant, S and Defrances, CJ (2013) Trends in inpatient hospital deaths: National hospital discharge survey, 2000–2010. NCHS Data Brief, 118, 1–8.Google ScholarPubMed
Harris, D (2007) Delirium in advanced disease. Postgraduate Medical Journal 83, 525–528.CrossRefGoogle ScholarPubMed
Hunstein, D, Sippel, B, Rode, D, et al. (2012) ePAAC© : Ergebnisorientiertes PflegeAssessment AcuteCare (Version 2.0), pp. 1–72.Google Scholar
Klein Klouwenberg, PM, Zaal, IJ, Spitoni, C, et al. (2014) The attributable mortality of delirium in critically ill patients: Prospective cohort study. British Medical Journal 349, g6652. doi:10.1136/bmj.g6652.CrossRefGoogle ScholarPubMed
Lawlor, PG, Gagnon, B, Mancini, IL, et al. (2000) Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine 160, 786–794.CrossRefGoogle ScholarPubMed
Maldonado, JR (2017) Acute brain failure: Pathophysiology, diagnosis, management, and sequelae of delirium. Critical Care Clinics 33, 461–519.CrossRefGoogle ScholarPubMed
Marrie, TJ and Wu, L (2005) Factors influencing in-hospital mortality in community-acquired pneumonia: A prospective study of patients not initially admitted to the ICU. Chest 127, 1260–1270.Google Scholar
McCoy, TH Jr., Hart, KL and Perlis, RH (2017) Characterizing and predicting rates of delirium across general hospital settings. General Hospital Psychiatry 46, 1–6. doi:10.1016/j.genhosppsych.2017.01.006.CrossRefGoogle ScholarPubMed
Meagher, D, O'Regan, N, Ryan, D, et al. (2014) Frequency of delirium and subsyndromal delirium in an adult acute hospital population. British Journal of Psychiatry 205, 478–485.CrossRefGoogle Scholar
Partridge, JS, Martin, FC, Harari, D, et al. (2013) The delirium experience: What is the effect on patients, relatives and staff and what can be done to modify this? International Journal of Geriatric Psychiatry 28, 804–812.CrossRefGoogle Scholar
Ryan, DJ, O'Regan, NA, Caoimh, RO, et al. (2013) Delirium in an adult acute hospital population: Predictors, prevalence and detection. BMJ Open 3, bmjopen-001772.CrossRefGoogle Scholar
Sanclemente, C, Barcons, M, Moleiro, MA, et al. (2004) Hospital mortality in an internal medicine service. Anales de Medicina Interna 21, 317–321.CrossRefGoogle Scholar
Schmitt, EM, Gallagher, J, Albuquerque, A, et al. (2019) Perspectives on the delirium experience and its burden: Common themes among older patients, their family caregivers, and nurses. Gerontologist 59, 327–337.CrossRefGoogle ScholarPubMed
Schubert, M, Schurch, R, Boettger, S, et al. (2018) A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - A cohort study. BMC Health Services Research 18, 550–3345.10.1186/s12913-018-3345-xCrossRefGoogle ScholarPubMed
Schuurmans, MJ, Shortridge-Baggett, LM and Duursma, SA (2003) The Delirium Observation Screening Scale: A screening instrument for delirium. Research and Theory for Nursing Practice 17, 31–50.10.1891/rtnp.17.1.31.53169CrossRefGoogle ScholarPubMed
Shidara, Y, Fujita, Y, Fukunaga, S, et al. (2016) In-hospital mortality after surgery: A retrospective cohort study in a Japanese university hospital. Springerplus 5, 680–2279.CrossRefGoogle Scholar
Siddiqui, S, Chua, M, Kumaresh, V, et al. (2017) A comparison of pre ICU admission SIRS, EWS and q SOFA scores for predicting mortality and length of stay in ICU. Journal of Critical Care 41, 191–193. doi:10.1016/j.jcrc.2017.05.017.CrossRefGoogle ScholarPubMed
Vandenbroucke, JP, von Elm, E, Altman, DG, et al. (2014) Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. International Journal of Surgery 12, 1500–1524.CrossRefGoogle ScholarPubMed
Watt, CL, Momoli, F, Ansari, MT, et al. (2019) The incidence and prevalence of delirium across palliative care settings: A systematic review. Palliative Medicine 33, 865–877.CrossRefGoogle ScholarPubMed
Weckmann, MT, Bay, C, Abu Ata, N, et al. (2014) Incidence and cause of delirium in hospitalized patients between the ages of 18 and 56: A retrospective chart review. International Journal of Palliative Care 2014, 7.CrossRefGoogle Scholar
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