Acute Delirium Management in Hospice and Palliative Care

Acute delirium is a serious neurocognitive disorder that is highly prevalent among individuals receiving hospice and palliative care. Delirium causes significant distress for patients, families, and healthcare providers while contributing to prolonged hospitalization, increased healthcare utilization and costs, a greater likelihood of institutionalization, shorter survival, and higher mortality. It is characterized by acute disturbances in attention and awareness that often fluctuate throughout the day and may present as hypoactive, hyperactive, or mixed psychomotor subtypes. Delirium can be challenging to identify because of its overlapping features with other neurocognitive disorders, such as dementia. Routine screening using validated assessment tools is essential for early identification and treatment. Effective prevention and management of delirium require a multifaceted, interprofessional approach that addresses modifiable risk factors, as well as the underlying acute medical causes. Hospice and palliative care nurses play a central role in implementing evidence-based nonpharmacological interventions and engaging family care partners to reduce symptom burden and improve outcomes through goal-concordant, supportive strategies, including early mobility, hydration, sleep-wake regulation, and careful pharmacological stewardship.