Delirium in Elderly Patients Triggers Substantial Healthcare Costs
January 18, 2008 — A study of elderly patients who were followed for 1 year after hospital discharge found that healthcare costs per day survived were 2.5 times higher for those who developed delirium in the hospital than for those who did not, largely due to the need for greater inpatient or nursing home care.


The authors estimate that the healthcare cost for delirium in the United States is $38 billion to $152 billion per year, which rivals the estimated costs for nonfatal falls ($19 billion) or diabetes ($91.8 billion).

“Our hope is that these results will draw attention to delirium as a serious condition with significant long-term implications," said lead investigator Douglas L. Leslie, PhD, from the Medical University of South Carolina, in Charleston, in a press release issued by the university. "Given that interventions exist that have been shown to reduce rates of delirium, at least some of these costs may be preventable."

The study is published in the January 14 issue of the Archives of Internal Medicine.

Delirium, which is characterized by an acute decline in cognition and attention, represents a common, severe problem among hospitalized older patients, occurring in 14% to 56% of such patients, the group writes. Delirium often initiates a cascade of events with functional decline and increased use of healthcare services, but previous studies of long-term costs associated with delirium have been limited, they note.

They group aimed to determine, in an elderly group of patients, the total direct healthcare costs during the first year after discharge from an index hospitalization.

The study sample consisted of 841 patients aged 70 years and older who were hospitalized at Yale-New Haven Hospital between 1995 and 1998 and who participated in a clinical trial for a delirium intervention strategy. The cohort had a mean age of 80.2 years (SD 6.4 years), and 61% were women.

During the index hospitalization, 109 patents (13%) developed delirium.

The researchers determined that the mean total healthcare costs in 2005 dollars per survival day in the year after hospital discharge was $461 (± $570) in the patients with delirium vs $166 (± $195) in the patients without delirium (P < .001). A total of 95% of the difference in cost was due to inpatient and nursing home care.

Using 3 different models, the authors estimated that total healthcare costs attributable to delirium ranged from $16,303 per year per patient to $64,421 per year per patient.

"This study is the first, to our knowledge, to document the costs associated with delirium across such a wide range of services (inpatient, intensive care unit, emergency department, outpatient, nursing home, home health, rehabilitation, and other services) and during such a long period," the group writes.

"Given that the condition is costly, increasing in magnitude with the aging population, and potentially preventable, increased efforts to prevent, detect, and treat delirium are urgently needed," they conclude.

Arch Intern Med. 2008; 168:27-32. Abstract