Delirium and agitation at the end of life

#### What you need to know Delirium is common in the last weeks or days of life.1 It can be distressing for patients and those around them. Successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life. #### Sources and selection criteria We searched Medline, Clinical Evidence, and the Cochrane Library using the terms delirium, terminal, terminal care, palliative care, palliative medicine, and end of life. Where possible we used systematic reviews and referenced these rather than the individual trials. Our search was limited to citations from 1990 to December 2015. We also searched the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network. Delirium is the abrupt onset of fluctuating confusion, inattention, and reduced awareness of the environment. Symptoms can affect different areas of cognition (memory, orientation, language, visuospatial ability, or perception) and may include hallucinations and disturbances in the sleep-wake cycle (box 1).2 Delirium can therefore be distressing to people who experience it and those around them.3 Delirium is classified into hyperactive (restlessness and agitated behaviour predominate), hypoactive (drowsiness and inactivity predominate), and mixed subtypes. The more subtle changes associated with the hypoactive form are often missed.4 #### Box 1: What are the symptoms?