BACKGROUND:
Confusion is common among ill patients and has broad consequences for their care and well being. The prevalence of confusion in hospice patients is unknown.
OBJECTIVES:
Describe the prevalence, severity, and manifestations of nurse-identified confusion and estimate the prevalence of delirium in hospice patients.
DESIGN:
Cross-sectional descriptive study.
SETTING:
Nineteen hospices in the Population-based Palliative Care Research Network (PoPCRN).
PATIENTS:
Adult patients receiving care from participating hospices, February 15 to April 1, 2000.
MEASUREMENT AND ANALYSIS:
Hospice nurses estimated prevalence, severity, behavioral manifestations, and consequences of confusion during the preceding week. Confused and not-confused patients were compared using standard bivariate and stratification techniques. Logistic regression identified manifestations associated with problematic confusion.
RESULTS:
Median age of the 299 patients was 78 years, 59% were female, 52% lived at home, and cancer was the most common diagnosis (54%). Fifty percent were confused during the preceding week, 36% of those were severely confused or disabled by confusion. Compared with non-confused patients, confused patients were less likely to have cancer (64% vs. 43%, p=0.001) and more likely to live in nursing home/assisted living (21% vs. 33%, p=0.01). Disorientation to time or place, impaired short-term memory, drowsiness, and easy distractibility were common manifestations of confusion. When present, confusion caused a problem for the patient, someone else, or both 79% of the time. Inappropriate mood, cancer diagnosis, agitation, and age were the variables predicting problematic confusion. Only 14% of confused patients met criteria for delirium.
Conclusions: Confusion among hospice patients was common, frequently severe, and usually problematic.
The abstract above is from an article submitted to the Journal of Palliative Medicine, Volume 5, Number 2, 10/02, pages 687-695
ESTIMATION OF CONFUSION PREVALENCE IN HOSPICE PATIENTS, by David E. Nowels, MD, MPH, Caroline Bublitz, MS,
Cordt T. Kassner, MA, and Jean S. Kutner, MD, MSPH
Thank you to the 19 PoPCRN sites that participated in this study. Please contact Cordt Kassner for reprints of this article.
GENERAL INFORMATION:
Based on our discussions with participants in PoPCRN, we believe that confusion - and especially agitated delirium - are major issues for patient management and a risk for difficult bereavement. We expect to identify how large a problem confusion is and to estimate the prevalence of delirious patients using data from this study. Currently, no data are published describing confusion with as many hospice patients as we have in this study. Additionally, we have included hospice patients with a variety of diagnoses - most of the published literature about confusion and delirium in terminal patients only addresses cancer patients. Finally, having data from 19 different hospices significantly increases the generalizability of our findings.
METHODS:
Data forms will be completed by the nurse who is providing care for the patient, based on their observations of the patient over the previous week. Pilot testing has shown that completion of the data collection form takes only 1-2 minutes. The results will allow us to describe patient problems associated with confusion and may lay a foundation for a larger project documenting the impact of delirium on hospice patients, their loved ones, and the care they receive.
RESULTS:
Based on data collected from 303 patients at 19 Hospice and Palliative Care Sites. Relevant findings identified thus far include: