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Critical Issues in Clinical Practice and Research

Peter G. Lawlor, MB, CCFP; Robin L. Fainsinger, MB, CCFP; Eduardo D. Bruera, MD

JAMA. 2000;284:2427-2429.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

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.

Epidemiology

The occurrence of delirium among elderly general medical patients ranges from 15% to more than 50%.⁵ This wide range of occurrence rates has likely . . . [Full Text of this Article]

Etiology and Diagnosis

Psychosocial Effects

Treatment

Future Directions

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).

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