Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients

Detalhes bibliográficos
Autor(a) principal: Brás Cruz, Rute
Data de Publicação: 2023
Outros Autores: P. Medeiros, Teresa, Rocha, Maria do Céu, M. Oliveira, Hugo
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.24950/rspmi.1752
Resumo: Introduction: Delirium is one of the most frequent complications in palliative care with a prevalence as high as 88% in the days preceding the end-of-life. Data on delirium home-based palliative care are scarce. The aim of this work is to characterize the population followed by a palliative care team, both in-hospital and at home, to assess the prevalence of delirium, the therapeutic strategy, its resolution, and the factors associated with the higher or lower prevalence of delirium. Methods: A retrospective cohort study was carried out, including all patients followed in the hospital and at home by a palliative care team in Portugal during the year of 2019. Results: A total of 496 patients were included, of whom 308 (62.1%) had in-hospital follow-ups. Delirium was identified in 112 (22.6%) of all patients and the first line drug used was haloperidol (51.8%). A total of 283 (57.1%) patients died, of whom 81 (28.6%) developed delirium. The occurrence of death was significantly higher in those who developed delirium (72.3%, p <0.001). Associated with higher incidence of delirium were identified in-hospital follow-up (27.9%, p <0.001), infection (53.9%, p <0.001), endocrine (84.6%, p <0.001) and ionic changes (55.0%, p <0.001), use of anticholinergics (54.1%, p = 0.001), antipsychotics (42.6%, p = 0.031), corticosteroids (37.7%, p = 0.008), and presence of brain metastasis (50.0%, p = 0.046). Conclusion: There is a significant prevalence of delirium in end-of-life patients, which is a predictor of poor prognosis. The implementation of quality palliative care with a multidisciplinary approach may provide more effective control of delirium and reduce its overall prevalence.
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spelling Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care PatientsPrevalência e Abordagem do Delirium em Doentes de Cuidados Paliativos em Regime de Internamento versus em Regime DomiciliárioCudados PaliativosDelírioDelíriumPalliative CareIntroduction: Delirium is one of the most frequent complications in palliative care with a prevalence as high as 88% in the days preceding the end-of-life. Data on delirium home-based palliative care are scarce. The aim of this work is to characterize the population followed by a palliative care team, both in-hospital and at home, to assess the prevalence of delirium, the therapeutic strategy, its resolution, and the factors associated with the higher or lower prevalence of delirium. Methods: A retrospective cohort study was carried out, including all patients followed in the hospital and at home by a palliative care team in Portugal during the year of 2019. Results: A total of 496 patients were included, of whom 308 (62.1%) had in-hospital follow-ups. Delirium was identified in 112 (22.6%) of all patients and the first line drug used was haloperidol (51.8%). A total of 283 (57.1%) patients died, of whom 81 (28.6%) developed delirium. The occurrence of death was significantly higher in those who developed delirium (72.3%, p <0.001). Associated with higher incidence of delirium were identified in-hospital follow-up (27.9%, p <0.001), infection (53.9%, p <0.001), endocrine (84.6%, p <0.001) and ionic changes (55.0%, p <0.001), use of anticholinergics (54.1%, p = 0.001), antipsychotics (42.6%, p = 0.031), corticosteroids (37.7%, p = 0.008), and presence of brain metastasis (50.0%, p = 0.046). Conclusion: There is a significant prevalence of delirium in end-of-life patients, which is a predictor of poor prognosis. The implementation of quality palliative care with a multidisciplinary approach may provide more effective control of delirium and reduce its overall prevalence.Introdução: O delirium é uma das complicações mais frequentes em cuidados paliativos com uma prevalência de 88% nos dias que precedem o fim de vida. Os dados sobre delirium no seguimento domiciliário em cuidados paliativos são escassos. O objetivo deste trabalho é caracterizar a população seguida por uma equipa de cuidados paliativos em regime intra-hospitalar e domiciliário, avaliar a prevalência de delirium, a estratégia terapêutica, o tempo de resolução e os fatores que se associam a maior ou menor prevalência de delirium. Métodos: Foi realizado um estudo de coorte retrospetivo, que incluiu todos os doentes acompanhados no hospital e no domicílio por uma equipa de cuidados paliativos em Portugal durante o ano de 2019. Resultados: Foram incluídos 496 doentes, dos quais 308 (62,1%) tiveram acompanhamento intra-hospitalar. Identificado delirium em 112 (22,6%) doentes e o fármaco de primeira linha foi o haloperidol (n = 58, 51,8%). Registaram-se 283 (57,1%) óbitos e a ocorrência de óbito foi significativamente maior naqueles que desenvolveram delirium (72,3%, p <0,001). Foram associadas a uma maior incidência de delirium o seguimento intra-hospitalar (27,9%, p <0,001), infeção (53,9%, p <0,001), alterações endócrinas (84,6%, p <0,001) e iónicas (55,0%, p <0,001), o uso de anticolinérgicos (54,1%, p = 0,001), antipsicóticos (42,6%, p = 0,031), corticosteroides (37,7%, p = 0,008) e a presença de metastização cerebral (50,0%, p = 0,046). Conclusão: Existe uma prevalência significativa de delirium em doentes em fim de vida, sendo este um preditor de mau prognóstico. A implementação de cuidados paliativos de qualidade com uma abordagem multidisciplinar pode proporcionar um controlo mais eficaz do delirium e reduzir sua prevalência geral.Sociedade Portuguesa de Medicina Interna2023-09-27info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.24950/rspmi.1752https://doi.org/10.24950/rspmi.1752Internal Medicine; Vol. 30 No. 3 (2023): Julho/Setembro; 173-179Medicina Interna; Vol. 30 N.º 3 (2023): Julho/Setembro; 173-1792183-99800872-671Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spmi.pt/index.php/rpmi/article/view/1752https://revista.spmi.pt/index.php/rpmi/article/view/1752/1786https://revista.spmi.pt/index.php/rpmi/article/view/1752/1825Direitos de Autor (c) 2023 Medicina Internainfo:eu-repo/semantics/openAccessBrás Cruz, RuteP. Medeiros, TeresaRocha, Maria do CéuM. Oliveira, Hugo2023-10-28T06:24:52Zoai:oai.revista.spmi.pt:article/1752Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:28:05.033977Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
Prevalência e Abordagem do Delirium em Doentes de Cuidados Paliativos em Regime de Internamento versus em Regime Domiciliário
title Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
spellingShingle Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
Brás Cruz, Rute
Cudados Paliativos
Delírio
Delírium
Palliative Care
title_short Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
title_full Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
title_fullStr Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
title_full_unstemmed Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
title_sort Prevalence and Management of Delirium in Inpatient and Home-Based Palliative Care Patients
author Brás Cruz, Rute
author_facet Brás Cruz, Rute
P. Medeiros, Teresa
Rocha, Maria do Céu
M. Oliveira, Hugo
author_role author
author2 P. Medeiros, Teresa
Rocha, Maria do Céu
M. Oliveira, Hugo
author2_role author
author
author
dc.contributor.author.fl_str_mv Brás Cruz, Rute
P. Medeiros, Teresa
Rocha, Maria do Céu
M. Oliveira, Hugo
dc.subject.por.fl_str_mv Cudados Paliativos
Delírio
Delírium
Palliative Care
topic Cudados Paliativos
Delírio
Delírium
Palliative Care
description Introduction: Delirium is one of the most frequent complications in palliative care with a prevalence as high as 88% in the days preceding the end-of-life. Data on delirium home-based palliative care are scarce. The aim of this work is to characterize the population followed by a palliative care team, both in-hospital and at home, to assess the prevalence of delirium, the therapeutic strategy, its resolution, and the factors associated with the higher or lower prevalence of delirium. Methods: A retrospective cohort study was carried out, including all patients followed in the hospital and at home by a palliative care team in Portugal during the year of 2019. Results: A total of 496 patients were included, of whom 308 (62.1%) had in-hospital follow-ups. Delirium was identified in 112 (22.6%) of all patients and the first line drug used was haloperidol (51.8%). A total of 283 (57.1%) patients died, of whom 81 (28.6%) developed delirium. The occurrence of death was significantly higher in those who developed delirium (72.3%, p <0.001). Associated with higher incidence of delirium were identified in-hospital follow-up (27.9%, p <0.001), infection (53.9%, p <0.001), endocrine (84.6%, p <0.001) and ionic changes (55.0%, p <0.001), use of anticholinergics (54.1%, p = 0.001), antipsychotics (42.6%, p = 0.031), corticosteroids (37.7%, p = 0.008), and presence of brain metastasis (50.0%, p = 0.046). Conclusion: There is a significant prevalence of delirium in end-of-life patients, which is a predictor of poor prognosis. The implementation of quality palliative care with a multidisciplinary approach may provide more effective control of delirium and reduce its overall prevalence.
publishDate 2023
dc.date.none.fl_str_mv 2023-09-27
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https://doi.org/10.24950/rspmi.1752
url https://doi.org/10.24950/rspmi.1752
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dc.relation.none.fl_str_mv https://revista.spmi.pt/index.php/rpmi/article/view/1752
https://revista.spmi.pt/index.php/rpmi/article/view/1752/1786
https://revista.spmi.pt/index.php/rpmi/article/view/1752/1825
dc.rights.driver.fl_str_mv Direitos de Autor (c) 2023 Medicina Interna
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rights_invalid_str_mv Direitos de Autor (c) 2023 Medicina Interna
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Medicina Interna
publisher.none.fl_str_mv Sociedade Portuguesa de Medicina Interna
dc.source.none.fl_str_mv Internal Medicine; Vol. 30 No. 3 (2023): Julho/Setembro; 173-179
Medicina Interna; Vol. 30 N.º 3 (2023): Julho/Setembro; 173-179
2183-9980
0872-671X
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