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. 2019 Sep;33(8):865-877.
doi: 10.1177/0269216319854944. Epub 2019 Jun 11.

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

Christine L Watt  1   2 , Franco Momoli  3   4   5 , Mohammed T Ansari  5 , Lindsey Sikora  6 , Shirley H Bush  1   2   3   7 , Annmarie Hosie  8 , Monisha Kabir  7 , Erin Rosenberg  9   10 , Salmaan Kanji  3   11   12 , Peter G Lawlor  1   2   3   7
Affiliations

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

Christine L Watt et al. Palliat Med. 2019 Sep.

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.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of studies included in systematic review.
Figure 2.
Figure 2.
Delirium incidence and prevalence rate by diagnostic tool used. MDAS: Memorial Delirium Assessment Scale; DSM: Diagnostic and Statistical Manual of Mental Disorders; CAM: Confusion Assessment Method; BCS: Bedside Confusion Scale; Nu-DESC: Nursing Delirium Screening Scale; ICD: International Classification of Diseases.
Figure 3.
Figure 3.
Incidence and prevalence of delirium across palliative care settings. Prev: prevalence.
Figure 4.
Figure 4.
Risk of bias of included studies and applicability to defined study population. Results of risk of bias and applicability assessment as outlined in Supplemental Table 2.
Figure 5.
Figure 5.
Meta-analyses of delirium point prevalence at the time of admission to inpatient palliative care units (n = 14 studies, 2502 total patients).
See this image and copyright information in PMC

Comment in

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