Delirium in an Unwell Elderly Patient - Psychiatrist in Palliative Care

BACKGROUND: End of life care is increasingly becoming complex and protracted with the advances in critical care medicine.(1) Prolongation of life in critically ill elderly comes with multiple issues related to ethics, quality of life and autonomy of the patient, care giver burden, financial issues, and interplay of complex medical issues affecting the well being of the patient and the caregiver.(2) Palliative Psychiatry is increasingly being recognised as a major subspecialty when it comes to dealing with these situations.(3) There is a high incidence of delirium in end stage palliative care with a prevalence as high as 88%(4). Here we report a patient with multiple critical medical issues who suffered with severe and protracted delirium. He was brought in owing to unmanageable aggression and sleep wake cycle reversal which made the caregivers totally helpless. The complexities in his care and considering the family’s wishes for not having any invasive treatment procedures are being discussed.