OP-38 Impact of delirium on prognosis in palliative care inpatients undergoing discharge planning to an aged care facility: a retrospective cohort study

<h3>Background</h3> Delirium adversely affects prognosis.¹ This study reviewed time to death in Palliative inpatients at defined intervals from discharge planning to post transfer to a Residential Aged Care Facility (RACF). The study aimed to determine if delirium defined by a positive Confusion Assessment Method (CAM) or Assessment Test for Delirium and Cognitive Impairment (4AT) could be used as a prognostic marker in the decision to discharge plan palliative inpatients to RACF. <h3>Methods</h3> Retrospectively collected CAM and 4AT scores from patients admitted to Concord Centre for Palliative Care (CCPC) Sydney over 18 months who underwent a discharge planning discussion and agreed to transfer to RACF where tabulated. 838 patients were admitted, and 124 patients (14.8%) agreed to transfer to a RACF. 1 patient wasn’t delirium screened and excluded, and 123 patients separated into delirium present or absent cohorts and compared to outcomes in table 1. <h3>Results</h3> 47 (37.9%) of patients were transferred to a RACF. No statistically significant difference was found between the proportion of patients with or without delirium who were transferred to a RACF, P value = 0.67, the survival time post transfer, P value = 0.38, the survival time from planning discussion to death, P value = 0.41, the proportion who survived until ACAT, P Value = 0.66 or survived 4 weeks post transfer. P value = 0.63. 58 (47.2%) patients had delirium. CAM suggested delirium in 49.4%, 4AT in 17.5%. <h3>Discussion</h3> This study aimed to increase prognostic accuracy and appropriate selection of palliative inpatients for RACF placement. The prevalence of delirium was 47.2% and is consistent with a recent systematic review (1) indicating prevalence in palliative inpatients of 6–74%. This study shows that delirium defined by a positive CAM or 4AT is not a prognostic factor in the decision to discharge plan palliative inpatients to RACF however invites further preferably prospective research relating delirium to prognostic outcomes. <h3>Reference</h3> Watt CL, Momoli F, Ansari MT, Sikora L, Bush SH, Hosie A, <i>et al</i>. The incidence and prevalence of delirium across palliative care settings: a systematic review. <i>Palliat Med</i> 2019 Sep;<b>33</b>(8):865–77.