Call for government action in response to ‘national emergency’

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Medical experts have described a brain condition that impacts more than 130,000 Australians each year as a ‘national emergency’.

The first Australian study of the burden of the condition, ‘The economic impact of delirium in Australia: a cost of illness study’, has been published in BMJ Open.

Delirium, which is a sudden, severe episode of confusion and impaired thinking, affects more than 130,000 Australians each year. The study finds it causes ten per cent of dementia cases and 900 deaths.

There are no approved treatments and medical experts say that, in addition to better prevention and care, research is urgently needed to identify the biological changes in the brain responsible for the condition.

Associate Professor Gideon Caplan, director of geriatric medicine at Prince of Wales Hospital in Sydney and President of the Australasian Delirium Association, said it is “time to declare a national emergency on delirium”.

“This is a horrifying illness which traps people in a nightmare state that can last days, weeks or even months. It’s all too often a case of suffering in silence as those affected cannot ask for help – and there are no treatment options available.

“People with delirium may believe they are being attacked by hospital staff or suffer from frightening hallucinations. It increases the likelihood of dying, can cause long-term damage to the brain, and result in trauma even when the episode is over,” he said.

“This condition strikes the sickest and most vulnerable in hospitals and aged care facilities where they should be at their safest.

“With an ageing population, rates of delirium are set to soar. Chronic missed diagnosis and a dearth of treatments and research makes it even more urgent that governments step in to help end the waking nightmares faced by these patients,” added Dr Caplan.

The study found that delirium costs the nation $8.8 billion each year, or $66,363 for each person with delirium. Of this, financial costs comprised $3.5 billion, or $26,726 per person with delirium, with the remaining $5.3 billion comprised of the value of healthy life lost.

Dr Caplan said he has written to federal health minister Greg Hunt to share the research and seek a meeting to discuss the urgent need for a National Delirium Strategy.

“We need federal, state and territory governments to work with us to combat delirium through a National Delirium Strategy that prioritises prevention, care and research.

“This will allow us to establish dedicated delirium units in hospitals, improve the diagnosis and care of these patients, and work towards identifying much-needed treatments,” said Dr Caplan.

The Australasian Delirium Association said it has identified a "perverse situation" in which the diagnosis of delirium could lead to a cut in hospital funding because the condition is classified as a hospital-acquired complication.

“Government investment would go a long way to support effective prevention, management and clinical research, which would not only improve lives but also reduce the astronomical cost and loss of life associated with delirium,” said Dr Caplan.

Delirium is difficult to diagnose, particularly silent (or hypoactive) delirium where the person is lying quietly in bed. There are no diagnostic blood tests, x-rays or scans, and the condition can strike suddenly while patients are not being observed, so it is missed in as many as two-thirds of cases.

Triggers for delirium include pneumonia, urinary tract infections, dehydration, certain medications including antipsychotic medicine, an over-full bladder and constipation.

Delirium can occur at any age, including in children who are very unwell but is most common in vulnerable older people, affecting as many as half those admitted to hospital who are aged 65 or over, almost 90 per cent of intensive care patients and around a quarter of aged care residents. It occurs in up to a third of all hospital admissions. It can also present in patients with chronic illness or advanced cancer.

“The current approach of ad hoc prevention isn’t good enough. Government investment in a National Delirium Strategy is needed to prioritise this condition. Until then, people will continue to suffer,” added Dr Caplan.