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Assessing the role of hydration in delirium at the end of life

Galanakis, Chrissia,b; Mayo, Nancy Ea,b,c; Gagnon, Brunob,c

Current Opinion in Supportive and Palliative Care: June 2011 - Volume 5 - Issue 2 - p 169–173
doi: 10.1097/SPC.0b013e3283462fdc
Psychological and cognitive problems: Edited by Sam H. Ahmedzai

Purpose of review Delirium is the most frequent neuropsychiatric disorder that affects the advanced cancer population who are receiving palliative care. There is limited evidence and much debate about the role of hydration in delirium management at the end of life. The purpose of this article is to review the literature on delirium management with regards to pharmacological management and hydration.

Recent findings Pharmacological management is the first line of treatment for delirium, whereby antipsychotics are the medication of choice. However, they have not been approved by the United States Food and Drug Administration for delirium management as there is insufficient evidence supporting their use. Hydration is a believed to be a key component of delirium reversibility; yet there are conflicting results on its efficacy as an intervention for delirium management. As there are few studies of good methodological quality on the topic and large variations in practice, the effectiveness of hydration as an alternative management option for delirium is unclear.

Summary More work is required to assess the role of hydration in delirium at the end of life. Given the lack of evidence-based research on hydration, more randomized clinical trials are needed to elucidate the effects of hydration as a delirium intervention.

aDepartment of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Canada

bDivision of Clinical Epidemiology, McGill University Health Centre, Canada

cDepartment of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada

Correspondence to Chrissi Galanakis, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Ave. West, Ross 4.27, Montreal, QC H3A 1A1, Canada Tel: +1 514 934 1934 x37066; fax: +1 514 843 1493; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.