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Palliat Med. 2019 Jun 11:269216319854944. doi: 10.1177/0269216319854944. [Epub ahead of print]

The incidence and prevalence of delirium across palliative care settings: A systematic review.

Watt CL1,2, Momoli F3,4,5, Ansari MT5, Sikora L6, Bush SH1,2,3,7, Hosie A8, Kabir M7, Rosenberg E9,10, Kanji S3,11,12, Lawlor PG1,2,3,7.

Author information

1
1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
2
2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.
3
3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.
4
4 Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
5
5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
6
6 Health Sciences Library, University of Ottawa, Ottawa, ON, Canada.
7
7 Bruyère Research Institute, Ottawa, ON, Canada.
8
8 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia.
9
9 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
10
10 Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada.
11
11 Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.
12
12 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Abstract

BACKGROUND:

Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed.

AIM:

Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings.

DESIGN:

This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment.

DATA SOURCES:

Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included.

RESULTS:

Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( n = 34) and mixed diagnoses ( n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used.

CONCLUSION:

Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.

KEYWORDS:

Delirium; incidence; palliative care; prevalence; systematic review

PMID:
31184538
DOI:
10.1177/0269216319854944

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