Circadian rhythm in end-of-life delirium: a secondary analysis of two randomized controlled trials

Circadian rhythm in end-of-life delirium: a secondary analysis of two randomized controlled trials
Journal of Pain and Symptom Management; by Sonal Admane, Sarah Pasyar, Roland Bassett Jr., Eduardo Bruera, David Hui; 4/25
Over 90% of patients with advanced cancer in the last weeks and days of life experience delirium, a neurocognitive syndrome associated with increased restlessness, agitation, hallucinations, and even violent behaviors. Long term psychological morbidity is also seen in caregivers, who may develop prolonged grief, anxiety, and post-traumatic stress disorder. Healthcare professionals caring for patients with delirium also report delirium-related distress, particularly in relation to patients with persistent restlessness and agitation. Delirious patients were more restless between 3 pm and 11 pm. This observation of “sundowning” may help clinicians to better anticipate this symptom, schedule monitoring and treatments, and educate patients and caregivers.