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.

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Available from: Linda Leo‐Summers, May 11, 2015
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    • "Delirious patients experience more postoperative complications[4], higher readmission rates, poorer functional out- comes[9], and increased length of stay[10]. The annual cost of delirium to the health care system in the United States is estimated to fall between US$38 billion and US$152 billion[11]. Delirium may persist for several weeks in up to a third of patients, leading to further increased morbidity and mortality[12]. "
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    ABSTRACT: Delirium is a common occurrence in patients undergoing major cardiac surgery and is associated with a number of adverse consequences for the individual, their family and the health system. Current approaches to the prevention of delirium include identifying those at risk together with various non-pharmacological and pharmacological strategies, although the efficacy of these is often modest. Emerging evidence suggests that melatonin may be biologically implicated in the development of delirium and that melatonin supplementation may be beneficial in reducing the incidence of delirium in medical and surgical patients. We designed this trial to determine whether melatonin reduces the incidence of delirium following cardiac surgery compared with placebo. The Healthy Heart-Mind trial is a randomized, double-blind, placebo-controlled clinical trial of 3 mg melatonin or matching placebo administered on seven consecutive days for the prevention of delirium following cardiac surgery. We will recruit 210 adult participants, aged 50 and older, undergoing elective or semi-elective cardiac surgery with the primary outcome of interest for this study being the difference in the incidence of delirium between the groups within 7 days of surgery. Secondary outcomes of interest include the difference between groups in the severity and duration of delirious episodes, hospital length of stay and referrals to mental health services during admission. In addition, we will assess differences in depressive and anxiety symptoms, as well as cognitive performance, at discharge and 3 months after surgery. The results of this trial will clarify whether melatonin reduces the incidence of delirium following cardiac surgery. Trial registration The trial is registered with the Australian Clinical Trials Registry, trial number ACTRN12615000819527 (10 August 2015).
    Full-text · Article · Dec 2016 · Trials
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    • "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). "

    Full-text · Article · Nov 2014 · Journal of Clinical Nursing
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    • "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). "
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    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.
    Full-text · Article · Oct 2014 · International Journal of Geriatric Psychiatry
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