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Multicomponent Geriatric Intervention for Elderly Inpatients With Delirium: Effects on Costs and Health-Related Quality of Life

¹ Unit of General Practice and ³ Clinics of Internal Medicine and Geriatrics, Helsinki University Hospital, Finland.
² Department of General Practice and Primary Health Care, and ⁶ Department of Public Health, University of Helsinki, Finland.
⁴ Department of Public Health Science and General Practice, University of Oulu, and Oulu University Hospital, Unit of General Practice, Finland.
⁵ Rheumatism Foundation Hospital, Heinola, Finland.
⁷ Finnish Office for Health Technology Assessment (FinOHTA/Stakes), Helsinki.

Address correspondence to Kaisu H. Pitkälä, MD, PhD, University of Helsinki, Department of General Practice and Primary Health Care, PO Box 41, 00014 University of Helsinki, Finland. E-mail: kaisu.pitkala{at}helsinki.fi

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 during the follow-up year, whereas the respective figure for the control group was 19,557 . The difference between the groups was nonsignificant (180 [95% CI, –5,006 to 5,064 ]).

Conclusions. Comprehensive geriatric intervention improved HRQoL without increasing overall costs of care.

Key Words: Delirium • Multicomponent geriatric treatment • Quality of life • Cost of care

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