Care of patients with delirium at the end of life

Delirium is the most common mental disorder at the end of life. In palliative care settings, agitated delirium is rarely overlooked and is usually aggressively treated, but can be mistaken for worsening pain. In contrast, hypoactive delirium is more common but is more likely to be overlooked or misdiagnosed as depression. Both forms of delirium result in substantial patient distress. Deliria resulting from dehydration or drugs, particularly opioids, are among the most treatable at the end of life. Neuroleptic medications are the recommended pharmacologic treatment for agitation associated with delirium; benzodiazepines will worsen confusion, but may be needed in the final hours of life to facilitate calm.