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Delirium

Delirium is a common and distressing neurocognitive syndrome in palliative care, affecting patients with advanced illness, particularly in the final stages of life. It is characterized by an acute disturbance in attention, awareness, and cognition, with symptoms that often fluctuate over time. Delirium may result from multiple contributing factors, including infection, dehydration, medication effects (particularly opioids and sedatives), metabolic disturbances, organ failure, and uncontrolled pain. Early recognition and identification of reversible causes are important, as appropriate management may improve patient comfort and quality of life when consistent with the individual’s goals of care. Prevention strategies focus on addressing modifiable risk factors through maintaining adequate hydration and nutrition where appropriate, optimizing pain and symptom control, minimizing the use of deliriogenic medications, promoting regular sleep–wake cycles, ensuring the use of sensory aids such as glasses and hearing aids, encouraging orientation through familiar people and environments, and supporting early mobilization when feasible. While not all episodes of delirium are preventable, particularly in the terminal phase of illness, a multidisciplinary approach that combines non-pharmacological interventions with individualized medical management can reduce its incidence and severity, while prioritizing patient comfort and family support.

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