ECHO Hamrahi 9th August 2022

Delirium in Palliative Care

Session 8
TIPS- APLI ECHO session

Faculty:

Gauri Godbole, Clinical Pharmacist (Aged and Palliative Care), Management of Delirium in Palliative Care

Dr Nisha Nadarajan, Palliative Care Advance Trainee, Presentation: Case presentation

Attendees: 23

The session started with a report on the recent evaluation of the program and topic requests from the survey respondents.

Gauri gave an excellent talk about the management of delirium in palliative care. She stressed the non-pharmacological approaches of re-orientation (including using hearing and visual aids), quiet and familiar surroundings and people, correcting dehydration or electrolyte disturbances, addressing anxiety and attempting to normalise the sleep-wake cycle. If medication is used, keeping to a minimum dose and frequency and assessing for adverse effects regularly, is advised.

Nisha’s case of an elderly, non-English speaking lady with osteopenic pelvic fractures, hypoxia from pneumonia, constipation and dehydration, and poorly controlled pain illustrated the complexity of managing delirium and the multiple co-contributing causes which are often present. We discussed the place of interventional procedures to manage her pain, the practical challenges of epidural insertion in a delirious patient and the way practice is influenced by what is possible and available in different settings, both across countries but also within countries and health services.