Delirium in the Terminally Ill

Abstract Delirium is one of the most common neuropsychiatric complications in the management of terminally ill patients. Delirium is characterized by an abrupt onset and fluctuating disturbance in arousal, attention, cognition, and perception. Delirium is a serious neuropsychiatric condition that is associated with increased morbidity and mortality, causing distress in patients, family members, and staff. Delirium signals a medical emergency. Emerging from significant physiologic disturbance, usually involving multiple medical etiologies, delirium requires prevention, early identification, and vigorous treatment. Unfortunately, delirium is often underrecognized, misdiagnosed, inappropriately treated, or untreated in the medical setting. Palliative care specialists and others who care for terminally ill patients must be able to diagnose delirium accurately, undertake appropriate assessment of etiologies, and understand the benefits and risks of pharmacologic and nonpharmacologic interventions currently available. This chapter presents a comprehensive overview of the epidemiology, pathophysiology, clinical features, assessment, and management of delirium in the terminally ill.