Risk factors for delirium in adult patients receiving specialist palliative care: A systematic review and meta-analysis

TY - JOUR

T1 - Risk factors for delirium in adult patients receiving specialist palliative care

T2 - A systematic review and meta-analysis

AU - Featherstone, Imogen

AU - Sheldon, Trevor

AU - Johnson, Miriam

AU - Woodhouse, Rebecca

AU - Boland, Jason W

AU - Hosie, Annmarie

AU - Lawlor, Peter

AU - Russell, Gregor

AU - Bush, Shirley

AU - Siddiqi, Najma

N1 - © The Author(s) 2021

PY - 2022/2/1

Y1 - 2022/2/1

N2 - 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.

AB - 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.

KW - Adult

KW - Delirium

KW - Hospice and Palliative Care Nursing

KW - Humans

KW - Male

KW - Palliative Care

KW - Prospective Studies

KW - Risk Factors

U2 - 10.1177/02692163211065278

DO - 10.1177/02692163211065278

M3 - Article

C2 - 34930056

SN - 0269-2163

VL - 36

SP - 254

EP - 267

JO - Palliative Medicine

JF - Palliative Medicine

IS - 2

ER -