Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care

Clinical Features of Delirium among Patients in the Intensive Care Unit According to Motor Subtype Classification: A Retrospective Longitudinal Study

PURPOSE

Delirium in the intensive care unit (ICU) poses a significant safety and socioeconomic burden to patients and caregivers. However, invasive interventions for managing delirium have severe drawbacks. To reduce unnecessary interventions during ICU hospitalization, we aimed to investigate the features of delirium among ICU patients according to the occurrence of hypoactive symptoms, which are not expected to require invasive intervention.

MATERIALS AND METHODS

Psychiatrists assessed all patients with delirium in the ICU during hospitalization. Patients were grouped into two groups: a "non-hypoactive" group that experienced the non-hypoactive motor subtype once or more or a "hypoactive only" group that only experienced the hypoactive motor subtype. Clinical variables routinely gathered for clinical management were collected from electronic medical records. Group comparisons and logistic regression analyses were conducted.

RESULTS

The non-hypoactive group had longer and more severe delirium episodes than the hypoactive only group. Although the non-hypoactive group was prescribed more antipsychotics and required restraints longer, the hypoactive only group also received both interventions. In multivariable logistic regression analysis, BUN [odds ratio (OR): 0.993, pH OR: 0.202], sodium (OR: 1.022), RASS score (OR: 1.308) and whether restraints were applied [OR: 1.579 (95% confidence interval 1.194-2.089), p<0.001] were significant predictors of hypoactive only group classification.

CONCLUSION

Managing and predicting delirium patients based on whether patients experienced non-hypoactive delirium may be clinically important. Variables obtained during the initial 48 hours can be used to determine which patients are likely to require invasive interventions.

Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study

INTRODUCTION/OBJECTIVES

There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors.

METHODS

We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate).

RESULTS

In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009).

CONCLUSIONS

The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.

Exploration of the impact of the COVID-19 pandemic on the mental health of home health care workers in Japan: a multicenter cross-sectional web-based survey

Background

The COVID-19 pandemic has caused home health care workers (home-HCWs) to experience anxiety. The mental health of home-HCWs and related factors during the COVID-19 pandemic have not been clarified; therefore, we aimed to investigate the status and associated factors of fear of COVID-19 infection, anxiety, and depression among home-HCWs in Japan.

Methods

We conducted a multicenter cross-sectional web-based anonymous survey of home-HCWs in August 2021, during the fifth wave of the pandemic in Japan. We surveyed members of facilities that provided home visit services during the COVID-19 pandemic. We measured the Japanese version of the Fear of COVID-19 scale (FCV-19S-J) and the Hospital Anxiety and Depression scale (HADS) as objective variables, and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (J-AITCS-II) as an explanatory variable.

Results

A total of 328 members of 37 facilities responded to the survey, and we ultimately analyzed 311 participants. The most frequent occupation was nurse (32.8%), followed by doctor (24.8%) and medical office staff (18.0%). The mean score of the FCV-19S-J was 16.5 ± 5.0 (7.0 – 31.0), and the prevalences of definitive anxiety and depression were 7.4% and 15.7%, respectively. Multivariate regression analysis revealed that the J-AITCS-II teamwork subscale was significantly negatively associated with FCV-19S-J, HADS-anxiety, and HADS-depression (β = -0.171, p = 0.004; β = -0.151, p = 0.012; β = -0.225, p < 0.001, respectively). Medical office staff showed significant positive associations with FCV-19S-J and HADS-depression (β = 0.219, p = 0.005; β = 0.201, p = 0.009, respectively), and medical social workers with HADS-anxiety and HADS-depression (β = -0.166, p = 0.011; β = -0.214, p < 0.001, respectively) compared with doctors. The unmet support need for expert lectures on COVID-19 was significantly positively associated with FCV-19S-J (β = 0.131, p = 0.048), and the unmet support need for support systems for psychological stress and emotional exhaustion was significantly positively associated with HADS-anxiety (β = 0.141, p = 0.022).

Conclusions

Fear of COVID-19 infection and depression of nurses, medical office staff, and other occupations was significantly higher than those of doctors. These findings suggest that non-physicians were more likely to be fearful and depressed during the COVID-19 pandemic; thus, it is necessary to tailor mental health support based on occupation in the home care setting.

Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey

Objective

Home care is one of the essential community health care services; thus, identifying changes of home care utilization before and during the COVID-19 pandemic would be useful for researchers and policymaker to reconsider the home care system, the support needed for home care staff, and the collaborative system with hospitals in the COVID-19 era. We conducted a multicenter cross-sectional web-based anonymous survey of the directors of home visit facilities in Japan in August 2021.

Results

A total of 33 participants from 37 facilities responded to the survey. The number of patients dying at home and newly requested home visits increased during the COVID-19 pandemic (74.2%, 71.0%). One possible reason was the restricted visitation of inpatient facilities (93.5%). The underlying disease that the largest number of participants perceived as having increased compared with before the COVID-19 pandemic was cancer (51.6%). There were no significant differences in being in a rural area or the number of doctors in perceived changes in home visit utilization. Our study indicated that the director of home visit facilities thought the number of patients dying at home and newly requested home visits had increased compared with before the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06128-7.

Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

OBJECTIVES

The aim of this study was to assess the prevalence of delirium, using the Assessment Test for Delirium and Cognitive Impairment (4AT) in end-of-life palliative care patients.

SUBJECTS AND METHODS

This retrospective cross-sectional study was conducted on end-of-life patients in a hospice or at home. All patients were evaluated with the 4AT for the presence of delirium.

RESULTS

Of the 461 patients analyzed, 76 (16.5%) were inpatients and 83.5% (385) outpatients. The median age was 79.5 (72-86) years, and 51.0% were female. According to the 4AT score, 126 patients (27.3%) had delirium (A4T ≥4) at admission, 28 (36.8%) were inpatients, and 98 (25.5%) outpatients. Around 33.8% of the cancer inpatients had delirium, while 20.6% of the cancer outpatients had delirium. The prevalence of delirium varied according to the setting, clinical condition, and life expectancy. In addition, 55.0% (11) actively dying inpatients, within 3 days, had delirium, and 56.7% (17) outpatients had delirium; while among those with life expectancy longer than 4 days, 30.4% (17) inpatients and 22.8% (81) outpatients were with delirium.

CONCLUSIONS

Our study confirms that delirium is common in cancer and noncancer palliative care patients. Further research on delirium in end-of-life palliative care patients should consider the complexity of palliative care of this population as well as of the characteristics of the settings.

A novel prediction model for the completion of six cycles of radium-223 treatment and survival in patients with metastatic castration-resistant prostate cancer

Purpose

We evaluated the predictive factors for completion of all six cycles of radium-223 (Ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). We also developed a novel prediction model for Ra-223 treatment completion using these predictors.

Methods

We retrospectively reviewed data from 122 patients with mCRPC who were treated with Ra-223. The predictive factors for the completion of six cycles of Ra-223 treatment were evaluated. Statistically significant predictive factors were then used to develop a prediction model for treatment completion. Finally, using this prediction model, we classified the overall survival (OS) of the entire cohort into three groups.

Results

We identified three significant variables as the predictive factors for treatment completion: baseline alkaline phosphatase (ALP) level, baseline hemoglobin (Hb) level, and baseline pain. The three groups generated using the prediction model were: group 1 (patients with three predictive factors, i.e., ALP < median, Hb ≥ median, and no pain), group 2 (patients with one to two predictive factors), and group 3 (patients without any predictive factors). The treatment completion rates differed between the three groups significantly. Furthermore, the OS also differed among the groups significantly.

Conclusion

Our study suggested that the baseline ALP level, baseline Hb level, and baseline pain were the predictive factors of completion of all six cycles of Ra-223 treatment in patients with mCRPC. Our prediction model consisting of these factors could predict not only the completion of Ra-223 treatment, but also the post-treatment survival. This model can thus be useful for selection of patients for Ra-223 treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03639-z.

Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

Objective: Delirium is common and highly distressing for the palliative care population. Until now, no study has systematically reviewed the risk factors of delirium in the palliative care population. Therefore, we performed a systematic review and meta-analysis to evaluate delirium risk factors among individuals receiving palliative care. Methods: We systematically searched PubMed, Medline, Embase, and Cochrane database to identify relevant observational studies from database inception to June 2021. The methodological quality of the eligible studies was assessed by the Newcastle Ottawa Scale. We estimated the pooled adjusted odds ratio (aOR) for individual risk factors using the inverse variance method. Results: Nine studies were included in the review (five prospective cohort studies, three retrospective case-control studies and one retrospective cross-section study). In pooled analyses, older age (aOR: 1.02, 95% CI: 1.01-1.04, I ² = 37%), male sex (aOR:1.80, 95% CI: 1.37-2.36, I ² = 7%), hypoxia (aOR: 0.87, 95% CI: 0.77-0.99, I ² = 0%), dehydration (aOR: 3.22, 95%CI: 1.75-5.94, I ² = 18%), cachexia (aOR:3.40, 95% CI: 1.69-6.85, I ² = 0%), opioid use (aOR: 2.49, 95%CI: 1.39-4.44, I ² = 0%), anticholinergic burden (aOR: 1.18, 95% CI: 1.07-1.30, I ² = 9%) and Eastern Cooperative Oncology Group Performance Status (aOR: 2.54, 95% CI: 1.56-4.14, I ² = 21%) were statistically significantly associated with delirium. Conclusion: The risk factors identified in our review can help to highlight the palliative care population at high risk of delirium. Appropriate strategies should be implemented to prevent delirium and improve the quality of palliative care services.