Purpose <p>The stability of delirium motor subtypes in palliative care is unknown. We examined the longitudinal changes in delirium motor subtypes during palliative care unit stay.</p> Methods <p>We performed a secondary analysis of a multicenter observational study involving patients with advanced cancer. We assessed delirium, its motor subtypes, and symptoms including agitation (Memorial Delirium Assessment Scale [MDAS] item 9) and communication capacity (Communication Capacity Scale [CCS] item 4) at admission (T0), on the day of Palliative Performance Scale decline to 20 (T1, immediately before death), and daily until death.</p> Results <p>We obtained 9,251 delirium assessments from 1,633 patients: 31% experienced hypoactive delirium without hyperactive delirium and 35% experienced hyperactive or mixed delirium during their stay. As for stability, 57% of patients with hypoactive delirium and 57% of those with hyperactive or mixed delirium at T0 remained in the same subtype until death. Further, 17% of patients with hypoactive delirium at T0 developed hyperactive or mixed delirium during their stay. Moreover, 47% of patients assessed at both T0 and T1 had a CCS item 4 &lt; 3 (maintained communication capacity) and MDAS item 9 &lt; 2 (no moderate-to-severe agitation) at T1. Patients with delirium (hyperactive, mixed, or hypoactive) at T0 were less likely to maintain communication capacity without moderate-to-severe agitation at T1 than patients without delirium at T0, after adjusting for covariates.</p> Conclusion <p>Considering the stability of delirium motor subtypes and the difficulty in balancing comfort with communication in palliative care, individualized delirium management goals should be discussed with caregivers.</p>