Multicomponent geriatric intervention for elderly inpatients with delirium: effects on costs and health-related quality of life.
BACKGROUND
The detrimental effects of delirium on functioning and mortality are well known, but health-related quality of life (HRQoL) and costs of care have rarely been investigated among patients with delirium. We studied the effects of multicomponent geriatric treatment on costs of care and HRQoL in delirious inpatients.


METHODS
A randomized, controlled trial of 174 inpatients with delirium was performed in an acute geriatric hospital. The intervention was individually tailored geriatric treatment. The HRQoL was measured by the 15D instrument and subjective health by a four-level ordinal scale. Health care costs including intervention costs were calculated for 1 year after the delirium episode.


RESULTS
Mean age of the patients was 83 years; 31% had prior dementia. After the index hospitalization for delirium, a greater proportion in the intervention group than in the control group stated that they felt healthy (71% vs 49%, p =.050). HRQoL deteriorated in both groups as a consequence of delirium. Deterioration was, however, slower in the intervention group (-0.026, 95% confidence interval [CI], -0.051 to -0.001) than in the control group (-0.065, 95% CI, -0.09 to -0.040; p =.034). Counting all costs of hospital care, long-term care, skilled home nursing visits, and costs related to intervention, the intervention group used, on average, 19,737 euro during the follow-up year, whereas the respective figure for the control group was 19,557 euro. The difference between the groups was nonsignificant (180 euro [95% CI, -5,006 to 5,064 euro]).


CONCLUSIONS
Comprehensive geriatric intervention improved HRQoL without increasing overall costs of care.
Pitkala
Kaisu H
KH
Unit of General Practice, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi
Laurila
Jouko V
JV
Strandberg
Timo E
TE
Kautiainen
Hannu
H
Sintonen
Harri
H
Tilvis
Reijo S
RS
D000368:Aged; D000369:Aged, 80 and over; D003191:Comprehensive Health Care / Q000191:economics*; D017281:Cost of Illness; D003693:Delirium / Q000191:economics* / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006782:Hospitals, Special / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D011788:Quality of Life