Delirium 2.0: What’s New and What Works for Palliative Care and Hospice Patients?

Key Message: Delirium affects the majority of seriously ill patients and causes distress for patients, families, and clinicians. This session equips participants with practical, evidence-based strategies aimed at recognition, interdisciplinary management, and effective communication about delirium. Participants will gain practical tools to improve patient outcomes and support families during this challenging complication.

Abstract:

Introduction:
Delirium is a common and distressing neuropsychiatric complication in seriously ill and palliative care patients, affecting up to 85–90% of hospice and palliative care patients at the end of life. and significantly impacting patients, families, and care teams (1-2). Despite its high prevalence, screening, identification, and management remain suboptimal in clinical practice. Barriers include lack of awareness and standardized approaches1. Delirium is associated with reduced quality of life, shortened survival, and increased healthcare costs (3).


Objectives:  
This session offers a practical, evidence-based update on delirium recognition, diagnosis, and management in serious illness, emphasizing the importance of early assessment to improve patient outcomes and reduce family distress. A central focus is the vital role of interdisciplinary teamwork; non-pharmacologic interventions, and coordinated involvement of physicians, nurses, social workers, and chaplains to enhance both clinical outcomes and the patient-family experience (5). The session highlights non-pharmacological interventions—such as environmental modifications and caregiver support—as first-line strategies, supported by robust evidence for prevention and treatment with minimal risk. It also addresses current controversies in pharmacologic management, including recent randomized controlled trials related to the efficacy and safety of antipsychotic and benzodiazepine medications (4). Through interactive case discussions, participants will learn to design tailored management plans, communicate effectively with patients and families, and document care decisions.


Conclusions:
Participants will be empowered to address delirium proactively using an evidence-based, interprofessional approach to enhance quality of care and reduce suffering for patients and families facing serious illness.

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Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911–922.
Neufeld, K. J., Yue, J., Robinson, T. N., Inouye, S. K., & Needham, D. M. (2020). Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: A systematic review and meta-analysis. Journal of the American Geriatrics Society, 68(11), 2470–2479.
Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in older persons: Advances in diagnosis and treatment. JAMA, 318(12), 1161–1174.