Comparison of haloperidol, non-haloperidol antipsychotics, and no pharmacotherapy for the management of delirium in an inpatient geriatric palliative care population

Abstract

Antipsychotics are frequently used for treatment of delirium, although little evidence exists that they improve delirium outcomes. Our objective was to evaluate haloperidol (HAL) compared to non-haloperidol antipsychotics (NHAP) or no pharmacologic treatment (NP) in the management of delirium in older adults under the care of a palliative care consult service across a large, integrated health care system.

A retrospective chart review examined data from September 2014-September 2015. All hospitalized patients ≥65 years old with a diagnosis of delirium during palliative care consultation were included (n = 304). Primary outcome was length of stay after delirium diagnosis. Secondary outcomes included delirium symptom length, sedation, and QTc prolongation. Univariate statistical tests, analysis of covariance, and multiple regression methods were used to compare groups.

Post-delirium length of stay in the HAL, NHAP, and NP groups were 8.5, 7.0, and 6.8 days, respectively (p = 0.19). Delirium duration in the HAL, NHAP, and NP groups were 6.7, 6.0, and 4.9 days, respectively (p = 0.05). Safety outcomes were statistically different than the reference group (NHAP).

Congruent with existing literature in other generalized patient populations, no significant difference in post-delirium length of stay existed in geriatric, palliative care population.

Keywords:

• delirium
• antipsychotics
• geriatrics
• palliative care

Prior presentation:

The preliminary results of this study were presented at the 2016 American College of Clinical Pharmacy Annual Meeting in Hollywood, FL in October 2016. The final results of this study were presented at the 2017 American Geriatrics Society Annual Meeting in San Antonio, TX in May 2017.

Acknowledgements

All individuals who have devoted significant work to this manuscript have been included as authors. Conflict of interest: None of the authors have any financial or other relationships that may lead to a conflict of interest. Author contributions: All authors (Maria Felton, Jennie B. Jarrett, Richard Hoffmaster, Frank J. D’Amico, Heather Sakely, Jennifer Pruskowski) contributed to concepts and design of the study. Corresponding author was responsible for data collection. Statistician, Frank D’Amico, was primarily responsible for analysis and interpretation of the data. This manuscript has been edited, read, and approved by all authors (Maria Felton, Jennie B. Jarrett, Richard Hoffmaster, Frank J. D’Amico, Heather Sakely, Jennifer Pruskowski). Sponsor’s role: There were no financial or personal sponsors for this study.

Conflict of interest

All authors meet the criteria for authorship. None of the authors have any financial or other relationships that may lead to a conflict of interest.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.