Cognitive function and vigilance of patients in a palliative care unit: A 1-day survey

The palliative care units attach much importance to maintain the awareness and cognitive functions of the patients. A 1-day assessment was performed on the 59 patients at the ''maison mEdicale Jeanne-Garnier'' (palliative care unit). Its purpose was to evaluate the consciousness of the patients (Rudkin score) and their cognitive abilities (TELECOM test, French version of the blessed orientation memory concentration test); a physician questionnaire was completed about the intention behind the use of drugs. Correlations were sought between these data, the length of stay and survival. Results.-Most of the patients were awaked (Rudkin score: 1.9 +/- 1.3) but 73% of the patients suffered from delirium (TELECOM test: 19 +/- 10). A cerebral dysfunction (39% of the patients) altered significantly the cognitive performances without repercussion on consciousness. Morphine or benzodiazepine doses were correlated with neither the awareness scores, nor the cognitive functions, nor the life expectancy. In our hospital, the use of sedation is not frequent: no sedation according to the SFAP definition was administered the day of the study. Our study shows the discrepancies between the practices of different units and that the patients were not always properly informed of the adverse effects of the drugs. The study enabled the different teams to familiarize themselves with simple tools and to speak a same language when assessing the level of consciousness to detect early delirium which is too often underestimated. (C) 2009 Elsevier Masson SAS. All rights reserved.