BMC geriatrics · 2026
Delirium care in crisis: a retrospective analysis of reduced hospitalizations during the COVID-19 pandemic in Germany.
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Diogo Nellessen Nils, Samehni Mohamad, Hohenstein Sven, Bollmann Andreas, Dengler Julius, Palm Frederick, Kukolja Juraj
Аннотация
BACKGROUND: The COVID-19 pandemic has caused profound shifts in healthcare utilization. Little is known about how this crisis affected the vulnerable group of patients with delirium on a system level. The goals of this study where to examine whether this crisis: (1) altered the number of inpatient admissions for delirium, (2) altered the number of hospital-based outpatient admissions for delirium, (3) affected disease burden, all-cause in-hospital mortality or length of stay for inpatient delirium cases.
MATERIALS AND METHODS: We retrospectively analysed routine and health claim data from 7,720 admissions for delirium from 86 German hospitals and compared pandemic and pre-pandemic data. We included all cases with the main discharge diagnosis from the International Classification of Disease-10 (ICD-10): "F05 Delirium, not induced by alcohol and other psychoactive substances" from 2019 to 2022. The mean age was 80.9 years in the pandemic period and 80.7 years in the pre-pandemic period. Admission rates, length of stay, disease burden (case mix, comorbidities) and complications (i.e., intensive care admission, all-cause in-hospital mortality) were assessed via (generalized) mixed models.
RESULTS: We observed a 20% decrease in inpatient admissions for delirium during the pandemic (p < 0.001). This reduction was not offset by hospital-based outpatient care. Case mix index values, individual secondary diagnoses and complications were unchanged or reduced during specific pandemic periods. Moreover, time all-cause in-hospital mortality remained unchanged. The proportion of elective admissions decreased from 18% to 12% (p < 0.001). The Length of hospital stay remained unchanged.
CONCLUSIONS: The COVID-19 pandemic was associated with a marked reduction in inpatient admissions for delirium, which was not offset by hospital-based outpatient care. Changes in admission patterns and disease burden indicators suggest altered thresholds and pathways for admissions for delirium during the pandemic. These findings point to potential gaps in access to inpatient delirium care during the pandemic. Such real-world evidence is essential for improving healthcare for vulnerable groups, such as those with delirium.
MATERIALS AND METHODS: We retrospectively analysed routine and health claim data from 7,720 admissions for delirium from 86 German hospitals and compared pandemic and pre-pandemic data. We included all cases with the main discharge diagnosis from the International Classification of Disease-10 (ICD-10): "F05 Delirium, not induced by alcohol and other psychoactive substances" from 2019 to 2022. The mean age was 80.9 years in the pandemic period and 80.7 years in the pre-pandemic period. Admission rates, length of stay, disease burden (case mix, comorbidities) and complications (i.e., intensive care admission, all-cause in-hospital mortality) were assessed via (generalized) mixed models.
RESULTS: We observed a 20% decrease in inpatient admissions for delirium during the pandemic (p < 0.001). This reduction was not offset by hospital-based outpatient care. Case mix index values, individual secondary diagnoses and complications were unchanged or reduced during specific pandemic periods. Moreover, time all-cause in-hospital mortality remained unchanged. The proportion of elective admissions decreased from 18% to 12% (p < 0.001). The Length of hospital stay remained unchanged.
CONCLUSIONS: The COVID-19 pandemic was associated with a marked reduction in inpatient admissions for delirium, which was not offset by hospital-based outpatient care. Changes in admission patterns and disease burden indicators suggest altered thresholds and pathways for admissions for delirium during the pandemic. These findings point to potential gaps in access to inpatient delirium care during the pandemic. Such real-world evidence is essential for improving healthcare for vulnerable groups, such as those with delirium.