Background Delirium adversely affects prognosis.¹ This study reviewed time to death in Palliative inpatients at defined intervals from discharge planning to post transfer to a Residential Aged Care Facility (RACF).

The study aimed to determine if delirium defined by a positive Confusion Assessment Method (CAM) or Assessment Test for Delirium and Cognitive Impairment (4AT) could be used as a prognostic marker in the decision to discharge plan palliative inpatients to RACF.

Methods Retrospectively collected CAM and 4AT scores from patients admitted to Concord Centre for Palliative Care (CCPC) Sydney over 18 months who underwent a discharge planning discussion and agreed to transfer to RACF where tabulated. 838 patients were admitted, and 124 patients (14.8%) agreed to transfer to a RACF. 1 patient wasn’t delirium screened and excluded, and 123 patients separated into delirium present or absent cohorts and compared to outcomes in table 1.

Results 47 (37.9%) of patients were transferred to a RACF. No statistically significant difference was found between the proportion of patients with or without delirium who were transferred to a RACF, P value = 0.67, the survival time post transfer, P value = 0.38, the survival time from planning discussion to death, P value = 0.41, the proportion who survived until ACAT, P Value = 0.66 or survived 4 weeks post transfer. P value = 0.63. 58 (47.2%) patients had delirium. CAM suggested delirium in 49.4%, 4AT in 17.5%.

Discussion This study aimed to increase prognostic accuracy and appropriate selection of palliative inpatients for RACF placement. The prevalence of delirium was 47.2% and is consistent with a recent systematic review (1) indicating prevalence in palliative inpatients of 6–74%. This study shows that delirium defined by a positive CAM or 4AT is not a prognostic factor in the decision to discharge plan palliative inpatients to RACF however invites further preferably prospective research relating delirium to prognostic outcomes.

Reference

1. Watt CL, Momoli F, Ansari MT, Sikora L, Bush SH, Hosie A, et al. The incidence and prevalence of delirium across palliative care settings: a systematic review. Palliat Med 2019 Sep;33(8):865–77.