title: Delirium diagnosis, screening and management.
abstract: OBJECTIVE
  Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care.
  
  
  RESULTS
  Delirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation.
  
  
  CONCLUSIONS
  Although formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.
authors.affiliation: aDepartment of Medicine Epidemiology and Community Medicine, Division of Palliative Care, University of Ottawa bThe Ottawa Hospital Research Institute cBruyère Research Institute dBruyère Continuing Care eDepartment of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Lawlor
authors.forename: Shirley H
authors.initials: SH
authors.lastname: Bush
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003693:Delirium / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives