Prevalence and Management of Dementia and Delirium in Hospice Acute Care Settings

BACKGROUND: Delirium is often not recognized by clinicians at hospice facilities, leading to the lack of beneficial interventions. The aim of this study is to find a baseline of how many patients show signs of delirium, dementia, or both, determine whether clinicians are recognizing these signs, and observe how dementia and delirium are being treated for these patients.

DESIGN: Patient charts were reviewed to obtain demographic information, medications, and patients' progress throughout stay including pharmacologic and non-pharmacologic interventions and results. Patients were then interviewed using the short portable mental status questionnaire.

SETTING: The prevalence and management of dementia and delirium was evaluated in 10 Hospice of the Valley inpatient settings.

RESULTS: Out of the 159 participants (mean age = 77.72 years), 93 (58.5%) presented with moderate to severe cognitive impairment, but only 38 participants (23.9%) had a formal diagnosis of dementia. Out of the 93 participants with significant cognitive impairment, 60 participants (65.6%) were treated with benzodiazepines and 82 (88.2%) were treated with opioids. Fifty-nine (63.4%) participants with cognitive impairment had documented non pharmacological interventions such as repositioning and reorientation, but only 22 (23.7%) participants received more meaningful non-pharmacological interventions such as hand massages, targeted videos, and favorite music.

CONCLUSIONS: The current study found a high prevalence of moderate to severe cognitive impairment without a diagnosis of dementia. A likely cause is the high frequency of opioids and benzodiazepines prescribed, causing drug-induced sedation and delirium which significantly impairs cognitive abilities. Safer alternatives, such as non-opioid pain medications, should be considered within the hospice population, especially given that age is a risk factor for delirium. A tool would be helpful to encourage staff to identify and document use of non-pharmacological interventions.