Diagnosing delirium in palliative care

Delirium is characterised by disturbances of attention, cognition (eg disorientation, language problems memory, perceptual changes) and awareness. Symptoms typically develop over hours or days and severity fluctuates. The fluctuating course can delay identification as patients may seem to be interacting quite normally at times.

The diagnosis of delirium in patients with palliative care needs involves a thorough assessment and examination, including:

• taking a history of changes in attention, cognition, consciousness and behaviour from the patient or a reliable source (eg carer)
• using a tool to help identify acutely altered cognition; see examples in the Psychotropic guidelines
• considering whether another condition could explain the changes in mental state (eg dementia, depression).

The aim of delirium assessment is to identify reversible cause(s) (see Risk factors for delirium in palliative care) that can be addressed in line with the patient’s goals of care and preferences. However, not all causes are reversible and sometimes no clear causative factor is identified. For more information on assessing delirium, see the Psychotropic guidelines.

In the last days of life, it may not be appropriate to comprehensively investigate delirium—for management of agitation in the last days of life, see Agitation and restlessness in the last days of life.