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Background: Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs., Aim: To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours., Design: A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners., Setting: Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland., Results: People who died in Scotland in 2016 ( n  = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified., Conclusion: Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.

Background: Delirium occurs in approximately 1 in 5 general hospital admissions and up to 85% of patients with terminal illness, but can be difficult to differentiation from other disorders, such as depression., Objective: The authors assessed and compared mood states as they relate to onset of delirium., Method: Symptoms of depression and delirium were assessed in 100 consecutive palliative-care admissions immediately after admission and 1 week later., Results: Overall, 51% experienced either major depression or delirium. Most patients with syndromal delirium also met criteria for major depressive illness, and 50% of those with depression had delirium or subsyndromal delirium (SSD). Delirium symptoms were less common in patients with major depression than depressive symptoms in patients with delirium or SSD., Discussion: Delirium should be considered in patients with altered mood states, and screening for depression should initially rule out delirium. Sustained alterations in mood may be more frequent in delirium than previously recognized.