Emily M Ellsworth1, Kevin J Bacigalupo1, Kavita R Palla1, Seema S Limaye1, Margaret J Walkosz1, Sandra T Szczecinski1, Katie J Suda1. 1. and are Clinical Pharmacy Specialists in Geriatrics; is the Director of Hospice and Palliative Medicine; is a Nurse Practitioner in Hospice and Palliative Care; and is the Nursing Manager of the Hospice and Palliative Care Unit; all at Edward Hines, Jr. Veterans Affairs (VA) Hospital. is a Research Health Scientist, Associate Director of Clinical Therapeutics, Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System and Professor of Medicine at University of Pittsburgh Division of General Internal Medicine both in Pennsylvania.
Abstract
BACKGROUND: The development of delirium is very common in terminally ill patients. However, risk factors for terminal delirium in the veteran population are poorly identified. The purpose of this study was to (1) Identify risk factors for terminal delirium in a US Department of Veterans Affairs inpatient hospice population; (2) Assess usage patterns of antipsychotics for treatment of terminal delirium; and (3) Describe nursing assessment, nonpharmacologic interventions, and documentation of terminal delirium. METHODS: This was a retrospective case-control study of veterans who expired while admitted into hospice care at a long-term care hospice unit during the period of October 1, 2013 to September 30, 2015. Veterans' medical records were reviewed for the 2 weeks prior to the recorded death. RESULTS: Of 307 veterans admitted for hospice care, 67.4% required antipsychotics in the last 2 weeks of life for the treatment of terminal delirium. The average number of antipsychotic doses given was 14.9 doses per patient. The risk factors that were identified included the use of steroids, opioids, or anticholinergics; Vietnam-era veterans with liver disease; veterans with cancer and a comorbid mental health disorder; and veterans with a history of drug and/or alcohol abuse. CONCLUSIONS: More than half of veterans admitted for hospice care experienced terminal delirium requiring treatment with antipsychotics. The identification of veterans most likely to develop terminal delirium will allow for early nonpharmacologic interventions and potentially decrease the need for treatment with antipsychotic medications.
BACKGROUND: The development of delirium is very common in terminally ill patients. However, risk factors for terminal delirium in the veteran population are poorly identified. The purpose of this study was to (1) Identify risk factors for terminal delirium in a US Department of Veterans Affairs inpatient hospice population; (2) Assess usage patterns of antipsychotics for treatment of terminal delirium; and (3) Describe nursing assessment, nonpharmacologic interventions, and documentation of terminal delirium. METHODS: This was a retrospective case-control study of veterans who expired while admitted into hospice care at a long-term care hospice unit during the period of October 1, 2013 to September 30, 2015. Veterans' medical records were reviewed for the 2 weeks prior to the recorded death. RESULTS: Of 307 veterans admitted for hospice care, 67.4% required antipsychotics in the last 2 weeks of life for the treatment of terminal delirium. The average number of antipsychotic doses given was 14.9 doses per patient. The risk factors that were identified included the use of steroids, opioids, or anticholinergics; Vietnam-era veterans with liver disease; veterans with cancer and a comorbid mental health disorder; and veterans with a history of drug and/or alcohol abuse. CONCLUSIONS: More than half of veterans admitted for hospice care experienced terminal delirium requiring treatment with antipsychotics. The identification of veterans most likely to develop terminal delirium will allow for early nonpharmacologic interventions and potentially decrease the need for treatment with antipsychotic medications.
Authors: Martine E Lokker; Lia van Zuylen; Carin C D van der Rijt; Agnes van der Heide Journal: J Pain Symptom Manage Date: 2013-06-18 Impact factor: 3.612
Authors: Shirley H Bush; Maeve M Leonard; Meera Agar; Juliet A Spiller; Annmarie Hosie; David Kenneth Wright; David J Meagher; David C Currow; Eduardo Bruera; Peter G Lawlor Journal: J Pain Symptom Manage Date: 2014-05-28 Impact factor: 3.612