One-Year Health Care Costs Associated With Delirium in the Elderly Population Editorial Comment

Department of Health Administration and Policy, Medical University of South Carolina, 151 Rutledge Ave, Bldg B, PO Box 250961, Charleston, SC 29425, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 02/2008; 168(1):27-32. DOI: 10.1001/archinternmed.2007.4
Source: PubMed


While delirium has been increasingly recognized as a serious and potentially preventable condition, its long-term implications are not well understood. This study determined the total 1-year health care costs associated with delirium.
Hospitalized patients aged 70 years and older who participated in a previous controlled clinical trial of a delirium prevention intervention at an academic medical center between 1995 and 1998 were followed up for 1 year after discharge. Total inflation-adjusted health care costs, calculated as either reimbursed amounts or hospital charges converted to costs, were computed by means of data from Medicare administrative files, hospital billing records, and the Connecticut Long-term Care Registry. Regression models were used to determine costs associated with delirium after adjusting for patient sociodemographic and clinical characteristics.
During the index hospitalization, 109 patients (13.0%) developed delirium while 732 did not. Patients with delirium had significantly higher unadjusted health care costs and survived fewer days. After adjusting for pertinent demographic and clinical characteristics, average costs per day survived among patients with delirium were more than 2(1/2) times the costs among patients without delirium. Total cost estimates attributable to delirium ranged from $16 303 to $64 421 per patient, implying that the national burden of delirium on the health care system ranges from $38 billion to $152 billion each year.
The economic impact of delirium is substantial, rivaling the health care costs of falls and diabetes mellitus. These results highlight the need for increased efforts to mitigate this clinically significant and costly disorder.

Download full-text


Available from: Linda Leo‐Summers, May 11, 2015
23 Reads
  • Source
    • "Of all health professionals, nurses experience the greatest distress and strain when caring for delirious patients (Leventhal et al. 2013). Delirium also impacts on the health care system, with admissions for elderly delirious patients costing two and a half times more for than those without delirium (Leslie et al. 2008). Fortunately, delirium can sometimes be prevented and is often reversible (National Clinical Guideline Centre for Acute & Chronic Conditions 2010). "
    Journal of Clinical Nursing 11/2014; 23(21-22). DOI:10.1111/jocn.12680 · 1.26 Impact Factor
  • Source
    • "It has a significant impact throughout health and social services and is associated with considerable health and socio-economic costs (Witlox et al., 2010). In the USA, it is estimated that the national health care cost for delirium ranges from $38 to 152bn per year (Leslie et al., 2008). As well as being associated with increased risk of long-term institutionalisation (Siddiqi et al., 2009) and dementia (Potter and George, 2006), delirium is recognised to be independently associated with higher mortality in older medical inpatients (Eeles et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Delirium is a common phenomenon in older people. Using a large mental health care data resource, we investigated mortality rates and predictors of mortality following delirium in older people.Methods The South London and Maudsley NHS Foundation Trust (SLAM) Clinical Record Interactive Search (CRIS) was used to retrieve anonymised data on patients known to mental health services who were over 65 years of age and received a diagnosis of delirium during a 3-year period. Age-standardised and gender-standardised mortality rates (SMRs) were calculated, and predictors of survival were investigated considering demographic factors, health status rated on the Health of the National Outcome Scale (HoNOS), cognitive function and previous or contemporaneous diagnosed dementia.ResultsIn 974 patients with delirium, 1- and 3-year mortality rates were 37.2 and 54.9% respectively, representing an SMR of 4.7 overall (95% CI: 4.3–5.1). SMR was 5.2 (95% CI: 4.6–5.7) for patients with delirium without prior dementia; SMR was 4.1 (95% CI: 3.6–4.7) for patients with dementia preceding delirium and 2.2 (2.0–2.5) excluding deaths within 6 months of the delirium diagnosis. Significant predictors of mortality in fully adjusted models were older age, male gender, white (compared with non-white) ethnicity, and HoNOS subscales measuring physical ill-health and functional impairment. No mortality associations were found with cognitive function, dementia, or psychological symptoms.Conclusions In people with delirium diagnosed by mental health services, mortality risk was high and predicted by demographic and physical health status rather than by cognitive function or psychological profile. © 2014 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 10/2014; 30(6). DOI:10.1002/gps.4195 · 2.87 Impact Factor
  • Source
    • "Moreover, as liver transplantation patients should be admitted to the ICU after surgery, it is inevitable that they face the risk of neurologic complications. Delirium in a patient admitted to the ICU increases treatment costs (Leslie et al., 2008; Milbrandt et al. 2004) because of the prolonged length of hospital stay (Saner et al., 2006; Thomason et al., 2005) and other associated health outcomes, including mortality (Ely et al., 2004; Leslie et al., 2005; McAvay et al., 2006; Saner et al., 2006). These reasons highlight the importance of an early intervention to prevent delirium in patients in the ICU. "
    [Show abstract] [Hide abstract]
    ABSTRACT: AimsThe aim of this study was to evaluate the effect of a delirium prevention strategy.BackgroundA high prevalence has been reported for delirium after liver transplantation surgery in the intensive care unit (ICU). Delirium increases treatment costs because of treatment delays, prolonged hospital stays and other associated complications. Despite all those problems associated with delirium, a systemic prevention strategy does not exist yet.DesignThis study used an economic evaluation design by reviewing relevant medical records.Methods Study objects were 130 patients who were admitted to the ICU after liver transplantation surgery. After looking at the medical records of these patients, we divided them into two groups according to the application of the prevention strategy. This study analysed the costs and benefits of the prevention strategy between the groups.ResultsThe prevalence rate of delirium was 35·3% in the prevention-care group and 51·6% in the usual-care group. A sum of $38·4 was invested for the prevention strategy in opposite to the expected total costs of $5578 for a probable treatment. Thus, the net benefit was $5539·6 with a benefit ratio of 145·3ConclusionsA strategy is necessary for the delirium prevention of patients in the ICU to decrease the economic burden.Relevance to clinical practiceThis study demonstrated that a prevention strategy was cost-effective because of its low input costs. With low additional investment, it is expected that this prevention strategy will be more available to other patients in the future.
    Nursing in Critical Care 10/2014; DOI:10.1111/nicc.12124 · 0.65 Impact Factor
Show more