Abstract
Delirium is a state of confusion that occurs in up to 90% of patients facing end-of-life. Despite its prevalence, there is a paucity of data that describes the prodrome to delirium. Family and caregivers are key observers of the phenomenology of delirium and often recall subtle signs and symptoms that herald the delirious episode. The objective of this study was to describe caregiver observations regarding the onset, characteristics, and progression of the predelirium state in hospice patients diagnosed with delirium. A purposive sample of 10 caregivers of hospice patients took part in private, semistructured, audiotaped interviews. The interviews were transcribed verbatim and analyzed using the Straussian approach to grounded theory. Six categories of commonalities emerged: physically declining, cognitively/psychologically declining, withdrawing, end-of-life awareness, deteriorating sleep pattern, and suffering. A process model was created that illustrates the temporal progression of sleep deterioration in the presence of overall decline, which leads to the diagnosis of delirium. In addition, the model illustrates the experience of suffering, which is woven throughout this temporal decline, becoming increasingly magnified as delirium progresses. These findings provide insight regarding early signs and symptoms of emerging delirium.