Featherstone I, Sheldon T, Johnson M, Woodhouse R, Boland JW, Hosie A, Lawlor P, Russell G, Bush S, Siddiqi N. Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis.
Palliat Med 2022;
36:254-267. [PMID:
34930056 DOI:
10.1177/02692163211065278]
[Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND
Delirium is common and distressing for patients receiving palliative care. Interventions targetting modifiable risk factors in other settings have been shown to prevent delirium. Research on delirium risk factors in palliative care can inform context-specific risk-reduction interventions.
AIM
To investigate risk factors for the development of delirium in adult patients receiving specialist palliative care.
DESIGN
Systematic review and meta-analysis (PROSPERO CRD42019157168).
DATA SOURCES
CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE and PsycINFO (1980-2021) were searched for studies reporting the association of risk factors with delirium incidence/prevalence for patients receiving specialist palliative care. Study risk of bias and certainty of evidence for each risk factor were assessed.
RESULTS
Of 28 included studies, 16 conducted only univariate analysis, 12 conducted multivariate analysis. The evidence for delirium risk factors was limited with low to very low certainty.
POTENTIALLY MODIFIABLE RISK FACTORS
Opioids and lower performance status were positively associated with delirium, with some evidence also for dehydration, hypoxaemia, sleep disturbance, liver dysfunction and infection. Mixed, or very limited, evidence was found for some factors targetted in multicomponent prevention interventions: sensory impairments, mobility, catheter use, polypharmacy (single study), pain, constipation, nutrition (mixed evidence).
NON-MODIFIABLE RISK FACTORS
Older age, male sex, primary brain cancer or brain metastases and lung cancer were positively associated with delirium.
CONCLUSIONS
Findings may usefully inform interventions to reduce delirium risk but more high quality prospective cohort studies are required to enable greater certainty about associations of different risk factors with delirium during specialist palliative care.
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