title: Psychiatric issues in palliative care: recognition of delirium in patients enrolled in hospice care.
abstract: OBJECTIVE
  Delirium is prevalent, difficult to assess, under-recognized, and undertreated in hospice and palliative care settings. Furthermore, it is associated with significant morbidity and mortality. Under-recognition of delirium results in under-treatment and increased suffering. The intent of this study was to retrospectively evaluate the recognition of delirium in a large cohort of hospice patients by interdisciplinary hospice care teams.
  
  
  METHODS
  A retrospective chart review of 2,716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of delirium in patients with advanced, life-threatening illnesses by front-line hospice clinicians. Documentation of "delirium" as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team.
  
  
  RESULTS
  Of the patients receiving home/long-term care, 17.8% (386/2168) had delirium documented as a diagnosis or significant problem. The presence of recognized delirium in this setting was associated with significant differences in marital status, ethnicity, hospice diagnosis, and age. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 28.3% (614/548) had delirium documented as a diagnosis or significant problem. Recognized delirium in this setting was associated with significant differences in gender, ethnicity, hospice diagnosis, and length of inpatient stay.
  
  
  CONCLUSIONS
  If documentation is representative of the care that the interdisciplinary teams provide, delirium of any kind appears to be under-recognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved delirium assessment is needed in order to minimize the impact of delirium on patients living with advanced, life-threatening illnesses and their caregivers.
authors.affiliation: Center for Palliative Studies, San Diego Hospice and Palliative Care, Department of Psychiatry, University of California, San Diego, La Jolla, California 92103, USA. sirwin@sdhospice.org
authors.forename: Scott A
authors.initials: SA
authors.lastname: Irwin
authors.forename: Sanjai
authors.initials: S
authors.lastname: Rao
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Bower
authors.forename: Joanna
authors.initials: J
authors.lastname: Palica
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Rao
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Maglione
authors.forename: Matt
authors.initials: M
authors.lastname: Soskins
authors.forename: Amy E
authors.initials: AE
authors.lastname: Betterton
authors.forename: Frank D
authors.initials: FD
authors.lastname: Ferris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017051:Hospice Care / Q000379:methods*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D012189:Retrospective Studies