I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences Karl Steinberg, MD, CMD, HMDC, HEC-C| March 27, 2024

https://psnet.ahrq.gov/web-mm/i-just-want-go-home-understanding-deliriums-impact-treatment-preferences A 76-year-old was readmitted for altered mental status after a recent hospitalization. He was experiencing hypoxia and required supplemental oxygen but was intermittently combative, repeatedly asked to go home and declined most medical interventions. His family, who lived a few hours away, acted as his medical decision-makers but were not able to travel to the hospital to see him. A treating clinician documented a discussion where the patient agreed to hospice enrollment however the palliative medicine consultant determined that he did not have capacity to make decisions due to delirium, nor was he clearly eligible for hospice. The care team and the patient’s family decided to continue to treat the patient’s underlying medical issues and to wait to see if his delirium improved. In subsequent days, the patient's mental status improved, and he was able to express opposition to hospice care. He was then transferred to a skilled nursing facility near his family for rehabilitation. The commentary discusses the importance of prompt identification and treatment of delirium, the role of shared decision-making with patients and their caregivers, and how clinicians should assess and address decisional capacity