Tallying the Costs of Dementia-Related Delirium

Hospitalized patients face increased one-year costs to Medicare, study finds

By MICHAEL CHMURA | Hebrew SeniorLife Research

3 min read

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Image: Cemile Bingol/Getty Images

New research by scientists at Harvard Medical School and Hebrew SeniorLife analyzing one-year health care costs for older hospitalized patients with Alzheimer’s disease and related dementias found costs were higher for those who had delirium than for those who did not.

This work, which examined costs not previously studied, found increased one-year Medicare costs of $34,828 in Alzheimer’s disease and related dementias patients with delirium versus those without, and found that increased costs for delirium in Alzheimer’s disease and related dementias occurred later during the 365-day study period.

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In patients with Alzheimer’s disease and related dementias, cost differences between those with and without delirium increased over one year after hospitalization. In patients without Alzheimer’s disease and related dementias, the parallel cost differences were consistent over time after hospitalization.

“Our findings suggest an increasing cost difference across one year for Alzheimer’s disease and related dementias patients with delirium compared to Alzheimer’s disease and related dementias patients without delirium,” said Tammy Hshieh, HMS assistant professor of medicine at Brigham and Women’s Hospital and assistant scientist at Hebrew SeniorLife.

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“Because delirium is preventable – patients and their families can advocate for nonpharmacologic interventions and vigilance during hospitalization to try to prevent the costly downstream cascade,” she said.

The findings are published in Alzheimer's & Dementia.

Medicare costs were determined prospectively at discharge and at 30, 90, and 365 days in 311 older adults after hospital admission.

Seventy-six patients had Alzheimer’s disease and related dementias and were more likely to develop delirium and die within one year.

In patients with Alzheimer’s disease and related dementias with delirium versus without, adjusted mean difference in costs associated with delirium were $34,828. with most of the excess costs being occurring between 90 and 365 days after admission.

In patients without Alzheimer’s disease and related dementias, delirium was associated with increased costs at all time points.

Excess costs associated with delirium in patients with Alzheimer’s disease and related dementias increased progressively over one year, whereas in in patients without Alzheimer’s disease and related dementias the increase was consistent across time periods.

The study findings highlight the complexity of health care costs in patients with Alzheimer’s disease and related dementias who develop delirium, a potentially preventable source of expenditures.

Additional authors included Ray Yun Gou, Richard Jones, Douglas Leslie, Edward Marcantonio, Guoquan Xu, Thomas Travison, Tamara Fong, Eva Schmitt, and Sharon Inouye.

Adapted from a Hebrew SeniorLife news release.