Its efficacy appears to be equivalent to that of morphine, provided a large enough dose is used. The adverse event profile is lower than that of many opioid analgesics of equivalent efficacy and the lack of respiratory and circulatory depression, in addition to a low constipating effect, indicates that it is a unique opioid of significant clinical potential. The apparent non-development of acute tolerance and the minimal likelihood of addiction make the agent a most attractive clinical addition. Key points Elderly patients with severe illness are at the greatest risk of developing delirium. The delirious patient undergoing palliative care can often be assessed in terms of metabolic factors and drug toxicity.
Multifactorial aetiology is very common.
Treatment recommendations underline the role of haloperidol as the first choice for most delirious states, excluding delirium tremens. The epidemiology, phenomenology and treatment of delirium in palliative medicine form an expanding interdisciplinary field. It is true that we turn to palliation when a cure cannot be found, but palliation is certainly not equivalent to 'there is nothing that can be done'. Concentrating on palliation does not mean that we are not good enough, that we have not tried hard enough or that we are professionally 'impotent'. In the field of sexuality, most caregivers have not yet reached the point where they can integrate the palliative approach into their clinical routine.