Delirium and Costs of Informal Home Care

We read with great interest the article by Leslie et al¹ on the costs associated with delirium. We would like to contribute to the topic with our own data, confirming the high burden of delirium in elderly patient care. We recently observed that delirium is a determinant of hospital readmission and institutionalization after discharge from a rehabilitation unit.² Furthermore, we demonstrated that patients with delirium during hospital admission have a lower functional level 1 year later compared with controls.³ These data are by themselves indirect indicators of higher costs (increased use of hospital and nursing homes). However, what is most important is the rate of functional impairment induced by delirium because delirious patients, once returning home, require a higher level of care in basic and instrumental activities of daily living. In Italy, the role of caregiving for elderly patients is usually committed to persons who are paid by their families because in our country the formal home-care system is rather poor and confined to a few areas of intervention. These persons, mostly women from eastern European countries, live with the elderly for 6 to 7 days a week, 24 hours daily. At present, we estimate that this workforce comprises approximately 900 000 persons, each one receiving approximately €1000 monthly. These costs are not reimbursed by the national health care system and burden families.