Delirium in a Palliative Care Unit

Abstract

Study design The Palliative Care Unit at the United Christian Hospital is a 20-bed hospice devoted to the care of the terminally ill cancer patients. All consecutive advanced cancer patients admitted as in-patients from 1 May to 30 August 2002 were potential participants. During that period, all patients were monitored daily for symptoms suggestive of delirium, such as attention disturbance, disorientation, hallucinations or delusions. Patients assessed as positive using Diagnostic and Statistical Manual of Mental Disorders (4th edition, DSM IV) criteria were assessed by the principal investigator (P. T. Lam) within the same working day for diagnostic conŽ rmation. Eligible patients underwent a structured evaluation, recording type of malignancy, sex, age, number of regular medications during onset of delirium, use of opioids, history of past delirium, psychiatric illness, dementia, or brain secondaries. Mini-mental state examination (MMSE) – Cantonese version(11) – and Karnofsky Performance Scale(12) were administered on referral. The Karnofsky Performance Scale was repeated at the onset of delirium. The severity of delirium was assessed using the Memorial Delirium Assessment Scale(13) (MDAS) administered by one experienced nursing ofŽ cer within 24 hours after the diagnosis. Type of delirium (hyperactive, hypoactive or mixed) was also recorded. All patients had a detailed historytaking and a complete neurological evaluation to identify underlying aetiologies, with routine laboratory tests, septic workup, relevant X-ray, CT brain scan, cerebrospinal  uid examination or electroencephalography where indicated. If the aetiologies of delirium were obvious on clinical Ž ndings, or if patients and/or family did not want medical interventions, the examinations would not be performed.