Pharmacologic Management of End-of-Life Delirium: Translating Evidence into Practice

Abstract

End-of-life delirium affects a vast majority of patients before death. It is highly distressing and often associated with restlessness or agitation. Unlike delirium in other settings, it is considered irreversible, and non-pharmacologic measures may be less feasible. The objective of this review is to provide an in-depth discussion of the clinical trials on delirium in the palliative care setting, with a particular focus on studies investigating pharmacologic interventions for end-of-life delirium. To date, only six randomized trials have examined pharmacologic options in palliative care populations, and only two have focused on end-of-life delirium. These studies suggest that neuroleptics and benzodiazepines may be beneficial for the control of the terminal restlessness or agitation associated with end-of-life delirium. However, existing studies have significant methodologic limitations. Further studies are needed to confirm these findings and examine novel therapeutic options to manage this distressing syndrome.

Keywords: antipsychotic agents; benzodiazepines; death; delirium; drug therapy; neoplasms; palliative care; randomized controlled trial; terminally ill.

Figure 1

RECORD (Rotation, Escalation, Combination, Or Reduction for Delirium) study design.

Figure 2

Management of end-of-life delirium.