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Predisposing and precipitating risk factors for delirium in palliative care patients

Published online by Cambridge University Press:  14 November 2019

Annina Seiler Open the ORCID record for Annina Seiler [Opens in a new window] ,
Maria Schubert ,
Caroline Hertler ,
Markus Schettle ,
David Blum ,
Matthias Guckenberger ,
Michael Weller ,
Jutta Ernst ,
Roland von Känel  and
Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window]
Annina Seiler*
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
University of Applied Science, School of Health Professions, Zurich, Switzerland
Caroline Hertler
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Markus Schettle
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
David Blum
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Matthias Guckenberger
Affiliation:
Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
Michael Weller
Affiliation:
Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
Jutta Ernst
Affiliation:
Center of Clinical Nursing Science, University Hospital Zurich and University of Zurich, Zurich, Switzerland
Roland von Känel
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
Soenke Boettger
Affiliation:
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
*
Author for correspondence: Annina Seiler, Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091Zurich, Switzerland. E-mail: annina.seiler@usz.ch
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Abstract

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.

Keywords

DeliriumPalliative care patientsPalliative treatmentPrecipitating factorsPredisposing factorsRisk factors
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 437 - 446
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Copyright
Copyright © Cambridge University Press 2019

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