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Diagnosis and Management of Delirium near the End of Life

David J. Casarett, MD, MA; Sharon K. Inouye, MD, MPH, American College of Physicians–American Society of Internal Medicine End-of-Life Care Consensus Panel*
[+] Article, Author, and Disclosure Information

From the Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; and Yale University School of Medicine, New Haven, Connecticut.

*This paper was written by David J. Casarett, MD, MA, and Sharon K. Inouye, MD, MPH, for the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) End-of-Life Care Consensus Panel. Members of the ACP–ASIM End-of-Life Care Consensus Panel were Bernard Lo, MD (Chair); Janet Abrahm, MD; Susan Block, MD; William Breitbart, MD; Ira R. Byock, MD; Kathy Faber-Langendoen, MD; Diane Meier, MD; Timothy E. Quill, MD; George Thibault, MD; and James Tulsky, MD. Primary staff to the Panel were Lois Snyder, JD (Project Director), and Jason Karlawish, MD. This paper was reviewed and approved by the Ethics and Human Rights Committee, although it does not represent official College policy. Members of the Ethics and Human Rights Committee were Risa Lavizzo-Mourey, MD (Chair); Susan Door Gould, MD; Joanne Lynn, MD; David A. Fleming, MD; William E. Golden, MD; Jay A. Jacobson, MD; David W. Potts, MD; Daniel P. Sulmasy, OFM, MD, PhD; Vincent Herrin, MD; and Lee J. Dunn Jr., JD, LLM.

Grant Support: Dr. Casarett is a recipient of a Research Career Development Award in Health Services Research from the Department of Veterans Affairs and is supported by grants from the Commonwealth Fund, the Greenwall Foundation, and the VistaCare Foundation. Dr. Inouye is a recipient of a Midcareer Award (#K24 AG00949) from the National Institute on Aging and a Donaghue Investigator Award (#DF98-105) from the Patrick and Catherine Weldon Donaghue Medical Research Foundation.

Requests for Single Reprints: Lois Snyder, JD, American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia PA 19106.

Current Author Addresses: Dr. Casarett: University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104.

Dr. Inouye: Yale University School of Medicine, PO Box 208096, 333 Cedar Street, New Haven, CT 06520-8096.

Ann Intern Med. 2001;135(1):32-40. doi:10.7326/0003-4819-135-1-200107030-00011
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Delirium is a common and distressing symptom that constitutes a significant challenge for end-of-life care. However, reliable techniques are available for the diagnosis of delirium, and effective therapies exist as well. This consensus paper uses a case-based format that begins with an overview of the definition and presentation of delirium. Next, strategies for diagnosis are suggested, with attention to the unique challenges that clinicians face in pursuing a diagnostic work-up for patients near the end of life. The paper concludes with a review of therapeutic options.





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