There are several issues that plaque patients when dealing with a terminal diagnosis. One of the most distressing for hospice care patients and their loved ones is delirium generally. This is the most common neuropsychiatric complication in patients as their condition takes a toll on their body. It happens in as many as 50% to 85% of patients in hospice care and is characterized by confusion, drowsiness, disorientation, inability to concentrate, and social withdrawal.
There are different types of delirium seen in patients under hospice care in facilities in Southern Indiana. These included hypoactive, hyperactive, and mixed delirium. In terminally ill patients, delirium is associated with dehydration, co-morbidities, medications, drug withdrawal, uncontrolled pain, and organ failure. However, the most common cause of delirium is the mental stress caused by a patient’s disease process. The following are some of the treatment approaches used for delirium in hospice care:
The use of drugs to manage delirium in terminally ill patients is one of the most common treatment modalities. The commonly used drugs, in this case, are antipsychotics and in particular haloperidol. The dosage of this drug will depend on the level of anxiety, restlessness, and risk of harming oneself in the patient. Since the drug is only used for a short period, the risk of suffering adverse side-effects in the patent is considerably reduced. Benzodiazepines such as sublingual lorazepam are also routinely used to manage delirium in patients who cannot handle an injection due to a decreased muscle mass.
There are times when pharmacologic intervention will do little to calm down a patient. In these cases, palliative sedation might be the solution. This is the administration of a sedative in set doses and combinations to reduce the level of consciousness in a patient as much as possible. The decreased consciousness will keep the patient calm, relieve their discomfort, and allow healthcare providers to address the underlying issue contributing to the delirium. This management option is, however, only used in acutely ill patients.
This is done for a patient and their loved ones. For the patient, it is combined with the use of medications to improve its efficiency. In counseling, the patient and their loved ones will understand the disease process. This will help them better cope with the symptoms a patient is experiencing and keep them calm. Psychoeducation of loved ones also helps them understand what they can do to calm a patient and improves the outcome of the various treatments used in hospice.
Exercise is one of the best methods of reducing anxiety in hospice patients, thus helping them to overcome delirium. Other than exercise, some centers employ art and music therapy and sleep enhancement to alleviate anxiety. Doing these complementary therapies allows for optimal control of mild delirium and improves a patient’s treatment outcomes.
Delirium has been linked to various poor outcomes in hospice care patients. There are various diagnostic tools that are used to ascertain this diagnosis before the start of treatment. The treatment alternatives mentioned above are designed to efficiently handle this distressing symptom and improve the quality of the end of life of patients with a terminal illness.