Author Affiliations: Grey Nun's Community Health Centre and Hospital, Edmonton Regional Palliative Care Program, and the Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton (Drs Lawlor and Fainsinger); M. D. Anderson Cancer Center and the Department of Symptom Control and Palliative Care, University of Texas, Houston (Dr Bruera).
Contempo Updates Section Editor: Stephen
J. Lurie, MD, PhD, Senior Editor.
Delirium frequently complicates care at the end of life. Although usually
described as a transient and potentially reversible disorder of cognition
and attention,1 paradoxically, delirium often
occurs in the last hours or days of life as an irreversible and terminal event.2 Cardinal features of delirium include acute onset
with a fluctuating course, the presence of an underlying organic derangement,
reduced sensorium, attention deficit, and cognitive or perceptual disturbances.3 Subtypes of delirium are classified according to altered
psychomotor activity, and may be hyperactive, hypoactive,1
or mixed.4 In this article, we discuss the
epidemiology of delirium at the end of life, as well as its etiology, assessment,
psychosocial impact, and treatment strategies and goals.
Lawlor PG, Fainsinger RL, Bruera ED. Delirium at the End of LifeCritical Issues in Clinical Practice and Research. JAMA. 2000;284(19):2427-2429. doi:10.1001/jama.284.19.2427