Delirium in terminally ill patients signals death is near

Certain types of delirium, particularly those of hypoactive and mixed kinds, are strong telltale signs of imminent death among critically ill cancer patients, a new study suggests. Researchers from Chonnam National University Medical School Gwangju in Korea say their findings might help doctors make more accurate predictions of survival in terminally ill patients.

In the study, published in the journal Psychosomatic Medicine: Journal of Biobehavioral Medicine, the team looked at the relationship between delirium and survival time in more than 300 patients with terminal cancer entering palliative care. Delirium is a condition wherein a person experiences confusion, altered awareness, or altered thoughts. This can result from many different illnesses, medications, and other causes.

The researchers divided delirium into subtypes: hyperactive delirium, with increased motor activity, loss of control, and restlessness; hypoactive delirium, with decreased activity, decreased speech, and reduced awareness. Mixed delirium, on the other hand, is used to classify patients with normal psychomotor activity or fluctuating activity levels. Among the participants, about 30 percent were diagnosed with delirium on entering palliative care. Of these, 15 percent of patients had hyperactive delirium, 34 percent had hypoactive and 51 percent experienced the mixed type.

For cancer patients entering palliative care, the median of survival time among those with delirium is 17 days, which is shorter compared to 28 days for those without delirium. However, the researchers note that the difference was significant only for patients with hypoactive or mixed delirium, with median survival times of 14 and 15 days, respectively. The survival time of patients with hyperactive delirium, the researchers say, was not different from that in patients without delirium. The team also discovered that while delirium was more common in older patients, the effects on time to death were actually stronger in younger patients. This finding supports earlier studies that suggest younger patients diagnosed with delirium have shorter survival times.

According to the researchers, the different survival times of each delirium subtype may be a result of the underlying causes of and treatment responses. For example, they say, hyperactive delirium is commonly associated with reversible causes, such as medication side effects. Hypoactive delirium, on the other hand, is generally related to hypoxia or decreased oxygen levels, metabolic disturbances, and multi-organ failure. This is perhaps the reason why hypoactive delirium could be associated with a higher mortality rate than hyperactive delirium, explains Dr Sung-Wan Kim, the study's lead author.

Accurate predictions of survival time in terminally ill patients are important for many reasons, Kim says, especially in terms of ensuring good clinical decision making, developing care strategies, and preparing for the end of life in a dignified manner. "The present findings could facilitate more precise predictions of survival, allowing families to prepare for the patient's death," he adds.

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