Informal Caregivers’ Administration of Opiate, Benzodiazepine, and Antipsychotic Medications to Home Hospice Patients Experiencing Hyperactive Delirium in the Last Week of Life

Purpose While hospice-prescribed comfort medications are used to manage hyperactive delirium (HD), the relationship between caregivers’ administration of these medications and HD is not well established, especially for patients receiving care in home settings. Methods A retrospective chart review was conducted on medication records of home-hospice patients (N = 19) experiencing HD in the last week of life. Medication use included scheduled and prn medications administered and converted to opiate, benzodiazepine, and antipsychotics dose equivalencies. A binomial generalized linear model predicting HD incidents by dose equivalencies and time from death was followed by Spearman correlation lag analyses to characterize associations between HD and medications. Results There were 2016 documented medication administrations and 133 HD incidents in the last week of life. After adjusting for covariation in measurements by patient, no medication class was a strong, independent predictor of HD. Opioid dose had a significant but modest positive association with HD incidents, but trends varied across patients. Shift-level lag analyses revealed HD episodes correlated with opioid and benzodiazepine doses in subsequent shifts more so than with doses in prior shifts, but neither lag transformation correlated more strongly than concurrent shift dose administration and HD. Conclusions The results highlight the intensity of pharmacologic management informal caregivers can face when managing HD in the last week without clinical staff on site. None of the 3 drug classes studied showed an inverse relationship to HD, raising questions about the efficacy of these medications for managing HD at the very end-of-life.