• Imogen Featherstone, Trevor Sheldon, Miriam Johnson, Rebecca Woodhouse, Jason W Boland, Annmarie Hosie, Peter Lawlor, Gregor Russell, Shirley Bush, and Najma Siddiqi.
• Department of Health Sciences, University of York, York, UK.
• Palliat Med. 2022 Feb 1; 36 (2): 254-267.

BackgroundDelirium is common and distressing for patients receiving palliative care. Interventions targetting modifiable risk factors in other settings have been shown to prevent delirium. Research on delirium risk factors in palliative care can inform context-specific risk-reduction interventions.AimTo investigate risk factors for the development of delirium in adult patients receiving specialist palliative care.DesignSystematic review and meta-analysis (PROSPERO CRD42019157168).Data SourcesCINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE and PsycINFO (1980-2021) were searched for studies reporting the association of risk factors with delirium incidence/prevalence for patients receiving specialist palliative care. Study risk of bias and certainty of evidence for each risk factor were assessed.ResultsOf 28 included studies, 16 conducted only univariate analysis, 12 conducted multivariate analysis. The evidence for delirium risk factors was limited with low to very low certainty.Potentially Modifiable Risk FactorsOpioids and lower performance status were positively associated with delirium, with some evidence also for dehydration, hypoxaemia, sleep disturbance, liver dysfunction and infection. Mixed, or very limited, evidence was found for some factors targetted in multicomponent prevention interventions: sensory impairments, mobility, catheter use, polypharmacy (single study), pain, constipation, nutrition (mixed evidence).Non Modifiable Risk FactorsOlder age, male sex, primary brain cancer or brain metastases and lung cancer were positively associated with delirium.ConclusionsFindings may usefully inform interventions to reduce delirium risk but more high quality prospective cohort studies are required to enable greater certainty about associations of different risk factors with delirium during specialist palliative care.

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