Delirium expert calls for more awareness

Delirium is one of the most prevalent clinical syndromes at the end of life, yet it is often missed and undertreated, a palliative care expert has said.

Dr Meera Agar, associate professor at the University of New South Wales and director of palliative care at HammondCare Braeside Hospital, will run a workshop on managing delirium ahead of the Australian Palliative Care Conference 2015.

“The symptoms [of delirium] are highly distressing to patients,” Agar said. “Untreated delirium symptoms won’t go away by themselves.”

During the workshop, Agar will also discuss the results of a recently completed delirium randomised control trial. The study looked at the use of anti-psychotic medications to treat specific delirium symptoms in people receiving palliative care.

“What we found is that not using anti-psychotic medications resulted in symptoms being better controlled than if you added either risperidone or haloperidol,” Agar said. “We shouldn’t be dismissive of simple interventions that can actually reverse precipitance of delirium, even at the end of life.”

She added that it’s also important to identify people with delirium early. “So often, the diagnosis is not made and not made early enough and an explanation is not given to the patient or their family about what delirium is and what might be able to be done to manage it. Early identification and a clear management plan is crucial.”

Agar said the symptoms of delirium could be quite subtle among palliative care patients. She explained indications might include a change in an individual’s usual manner, or inattention. Further assessment is then needed to detect delirium.