Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Dine A D Jennes; Tim Biesbrouck; Maaike L De Roo; Tinne Smets; Nele Van Den Noortgate

doi:10.3390/geriatrics9020051

Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients

Geriatrics (Basel). 2024 Apr 18;9(2):51. doi: 10.3390/geriatrics9020051.

Authors

Dine A D Jennes¹, Tim Biesbrouck^{2

3}, Maaike L De Roo^{2

3}, Tinne Smets⁴, Nele Van Den Noortgate^{4

5}

Affiliations

¹ Department of Geriatric Medicine, Antwerp University Hospital, 2650 Edegem, Belgium.
² Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium.
³ Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000 Leuven, Belgium.
⁴ End-of-Life Care Research Group, Vrije Universiteit Brussel [VUB] and Ghent University, 1090 Brussels, Belgium.
⁵ Department of Geriatric Medicine, Ghent University Hospital, 9000 Ghent, Belgium.

Abstract

Context: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established.

Objectives: To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients.

Methods: A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines.

Results: Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients.

Conclusions: This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.

Keywords: anxiety; confusion; delirium; frailty; review; terminal care.

Publication types

Review

Grants and funding

This work was conducted for the development of a clinical practice guideline which is part of the ‘Development, implementation and evaluation of the Nursing home Care Program for the Last days of Life’. The end-of-life-care research group responsible for the development of this program was supported by ‘Kom op tegen Kanker’ vzw (KOTK/2019/11317). The authors of this review did not receive direct funding.