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Delirium in the terminally ill.

W Breitbart1, D Strout

  • 1Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

Clinics in Geriatric Medicine
|April 28, 2000
PubMed
Summary

Delirium affects up to 85% of terminally ill patients, impacting symptom management. Effective nonpharmacologic, pharmacologic, and sedation strategies can control delirium symptoms in end-of-life care.

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Area of Science:

  • Palliative Care
  • Geriatrics
  • Neuroscience

Background:

  • Delirium is a common and serious condition in terminally ill patients, particularly near the end of life.
  • Cognitive impairment, a hallmark of delirium, affects up to 85% of patients in their final weeks.
  • Delirium significantly increases patient morbidity and complicates the management of pain and other symptoms.

Purpose of the Study:

  • To review the prevalence and management of delirium in terminally ill patients.
  • To discuss the effectiveness of various interventions for controlling delirium symptoms.
  • To highlight the role of neuroleptics and sedation in managing this condition.

Main Methods:

  • Literature review of studies on delirium in terminally ill patients.
  • Analysis of nonpharmacologic and pharmacologic treatment approaches.
  • Evaluation of the efficacy of haloperidol, newer neuroleptics, and sedation.

Main Results:

  • Nonpharmacologic and pharmacologic interventions demonstrate effectiveness in managing delirium symptoms.
  • Haloperidol and other novel neuroleptics offer a safe and effective option for some patients.
  • Sedation is a necessary management strategy for approximately one-third of patients with refractory delirium.

Conclusions:

  • Delirium is a prevalent and challenging condition in terminally ill patients requiring multifaceted management.
  • Pharmacologic agents, including neuroleptics, are valuable tools, but sedation may be essential for symptom control in some cases.
  • Optimizing delirium management is crucial for improving the quality of life for patients nearing the end of life.

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