Confusion in the terminally ill: recognition and management

Pain has been managed aggressively by hospice programs. However, other problems, particularly neuropsychiatric problems, such as confusion, can go unrecognized and untreated even in a hospice setting. The resulting disturbing, violent or disruptive behavior will severely detract from the quality of life the patient and family can share together. Dementia and delirium can be diagnosed using a mental status exam. Care-givers can then be informed about the special needs of the patients and prepared for potential problems. Identification of reversible causes for delirium can continue while agitated behavior is managed with behavioral and pharmacologic approaches. Confusion is a common problem in the terminally ill and prompt recognition and management of the potentially disruptive symptom can do a great deal to maximize the quality of the patient's life.