Delirium-Related Distress of Hospitalised Older Adults Within the Framework of the Theory of Unpleasant Symptoms: A Scoping Review of Qualitative Literature.

Delirium, experienced by up to 50% of hospitalised older adults, continues to be underrecognised, undertreated, and often confused with depression or dementia. Distress is a frequent and impactful symptom experienced in delirium, encompassing the individual's holistic biological or emotional response. Delirium-related distress has been shown to extend beyond the experience of the patient to include the care partners and nurses who are witnesses to delirium. The essence of delirium-related distress can be best understood through qualitative methodologies; therefore, this review explored the qualitative literature to summarise what is known about delirium-related distress in hospitalised older adults, their care partners, and the nurses who care for them. The Arksey and O'Malley methodological framework guided the process of conducting this scoping review, and the main concepts of the population, concept, and context were identified per the Joanna Briggs Institute scoping review methodology. A total of fourteen studies were included in this review, spanning qualitative study designs or mixed-methods designs that reported qualitative data. The Theory of Unpleasant Symptoms framework was used to categorise the factors that influence delirium-related distress and the symptom's consequences. This scoping review highlighted aspects of this phenomenon that have been less studied qualitatively, namely, the experiences of care partners and nurses, patients with delirium superimposed on dementia, and potential variations in how delirium-related distress is experienced over time, from acute care to transitional care to long-term care.