The financial and social costs of delirium

Caplan, Gideon A.; Teodorczuk, Andrew; Streatfeild, Jared; Agar, Meera

doi:10.1007/s41999-019-00257-2

Cited by 46 publications

(38 citation statements)

References 30 publications

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“…Nevertheless, widespread implementation in regular care is still lacking. Probable reasons are underestimation of long term delirium impact, the considerable staff investment, lack of knowledge concerning effective preventive strategies, difficulties in estimating the health economic cost of delirium [ 65 , 66 ]. Involvement of caregivers could reduce the need of volunteer-based prevention strategies and thereby health care costs.…”

Section: Discussionmentioning

confidence: 99%

A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project

et al. 2021

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Background Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. TRADE (TRAnsport and DElirium in older people) was set up to investigate i) the impact of transfer and/or discharge on the onset of delirium in older adults and ii) feasibility and acceptance of a developed complex intervention targeting caregiver’s participation during and after hospital discharge or transfer on cognition and the onset of delirium in older adults. Methods The study is designed according to the guidelines of the UK Medical Research Council (MRC) for development and evaluation of complex interventions and comprises two steps: development and feasibility/piloting. The development phase includes i) a multicenter observational prospective cohort study to assess delirium incidence and cognitive decline associated with transfer and discharge, ii) a systematic review of the literature, iii) stakeholder focus group interviews and iv) an expert workshop followed by a Delphi survey. Based on this information, a complex intervention to better and systematically involve family caregivers in discharge and transport was developed. The intervention will be tested in a pilot study using a stepped wedge design with a detailed process and health economic evaluation. The study is conducted at four acute care hospitals in southwest Germany. Primary endpoints are the delirium incidence and cognitive function. Secondary endpoints include prevalence of caregiver companionship, functional decline, cost and cost effectiveness, quality of discharge management and quality of admission management in admitting hospitals or nursing homes. Data will be collected prior to discharge as well as after 3, 7 and 90 days. Discussion TRADE will help to evaluate transfer and discharge as a possible risk factor for delirium. In addition, TRADE evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study. Trial registration DRKS (Deutsches Register für klinische Studien) DRKS00017828. Registered on 17th September 2019. Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project

et al. 2021

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“…Delirium increases the cost of hospitalization and the need for post‐acute care, resulting in higher healthcare expenditure and places a possible financial burden on informal caregivers. Prevention of delirium not only reduces the cost of delirium but also may decrease subsequent rates of dementia (Caplan et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences of delirium: A systematic review and meta‐summary of qualitative research

Kuusisto-Gussmann

Höckelmann

Lühe

et al. 2021

Journal of Advanced Nursing

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Aims The purpose of this systematic review and meta‐summary was the aggregation of the empirical qualitative literature on patients’ experiences of delirium in order to support the development and implementation of patient‐oriented delirium management and to guide future research. Design We conducted a systematic literature review of qualitative research published between January 1980 and June 2019. Data sources In June 2019, we searched in Medline, CINAHL, SSCI and PsycInfo to identify relevant reports. In addition, we conducted searches in three dissertation databases (BASE, DART and ProQuest) and Google Scholar. Review methods We used methods developed by Sandelowski and Barroso to construct a meta‐summary of the findings by extracting them from the reports, abstracting them into meta‐ findings and calculating their manifest interstudy frequency effect sizes. Results Out of the 742 identified records, 24 reports based on delirium experience accounts of 483 patients met our criteria and were included. One thousand ninety‐seven findings were extracted from these reports and abstracted into 92 meta‐findings. These were grouped to the five emerging themes ‘perception’, ‘emotions’, ‘interaction with others’, ‘dealing with delirium’ and ‘influence on further life’. Conclusion Delirium is commonly perceived as an overall distressing condition, which can accompany and influence patients even after hospital discharge. Impact This systematic review and meta‐summary is the most comprehensive aggregation of qualitative research of the patient delirium experience to date. It allows us to better understand, extract meaning from, and weigh the qualitative findings in their context by calculating their manifest frequency effect sizes. This can be used to support the development and implementation of delirium management concepts.

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“…The condition harms patients by increasing mortality risk during hospitalization, prolonging hospital stay, and diminishing independence and cognitive function after discharge (3)(4)(5)(6)(7)(8). Furthermore, delirium imposes considerable financial costs on health care systems (9).…”

Section: Introductionmentioning

confidence: 99%

Hospital Admission to a Window-Side Bed Does Not Prevent Delirium: A Retrospective Cohort Study of Older Medical Inpatients in General Wards

et al. 2021

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Background: Delirium in older inpatients is a serious problem. The presence of a window in the intensive care unit has been reported to improve delirium. However, no study has investigated whether window-side bed placement is also effective for delirium prevention in a general ward.Objectives: This study aims to clarify the association between admission to a window-side bed and delirium development in older patients in a general ward.Design: This research is designed as a retrospective cohort study of older patients admitted to the internal medicine departments of Shinshu University Hospital, Japan.Participants: The inclusion criteria were the following: (1) admitted to hospital internal medicine departments between April 2009 and December 2018, (2) older than 75 years, (3) admitted to a multi-patient room in a general ward, and (4) unplanned admission. The number of eligible patients was 1,556.Exposure: This study is a comparison of 495 patients assigned to a window-side bed (window group) with 1,061 patients assigned to a non-window-side bed (non-window group). When patients were transferred to the other type bed after admission, observation was censored.Main Measures: The main outcome of interest was “delirium with event” (e.g., the use of medication or physical restraint for delirium) within 14 days after admission as surveyed by medical chart review in a blinded manner.Key Results: The patients had a median age of 80 years and 38.1% were female. The main outcome was recorded in 36 patients in the window group (10.7 per thousand person-days) and 84 in the non-window group (11.7 per thousand person-days). Log-rank testing showed no significant difference between the groups (p = 0.78). Multivariate analysis with Cox regression modeling also revealed no significant association for the window group with main outcome development (adjusted hazard ratio 0.90, 95% confidence interval of 0.61–1.34).Conclusions: Admission to a window-side bed did not prevent delirium development in older patients admitted to a general ward.

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The financial and social costs of delirium

Cited by 46 publications

References 30 publications

A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project

A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project

Patients’ experiences of delirium: A systematic review and meta‐summary of qualitative research

Hospital Admission to a Window-Side Bed Does Not Prevent Delirium: A Retrospective Cohort Study of Older Medical Inpatients in General Wards

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