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Regarding this valuable presentation about the need for perioperative geriatric care, we would like to point out that timely initiation of individual preventive measures through multicomponent intervention can reduce the prevalence and incidence of delirium in hospitals (1, 2). To date, appropriately structured concepts have only rarely been used in Germany. To prevent delirium and postoperative cognitive dysfunction (POCD), the multicenter study PAWEL was launched in 2017, funded by the Innovation Fund of the Federal Joint Committee (G-BA, Gemeinsamer Bundes­aus­schuss) (3, 4). For this, more than 1200 patients from seven hospitals were recruited, screened pre-admission and post-discharge, and randomly assigned to a daily multimodal intervention.

In addition to evaluating the perioperative delirium prevalence, the project focuses on developing a risk score for preoperative detection of delirium risk and for implementing a three-level, multi-professional training concept for care providers. A multicenter delirium study will be carried out for the first time in Europe, on a large German cohort, which will assess the prevalence of POCD at 2, 6, and 12 months postoperatively as well as its range of influence by non-pharmacological measures.

Special attention will be paid to the health economic evaluation (in cooperation with the University of Duisburg-Essen and the public health insurance company Allgemeine Ortskrankenkasse [AOK] Baden-Württemberg), in which costs of potential consequences of delirium will be recorded. The care structure analysis aims to show that cross-sectoral intervention with multi-professional training and daily prevention based on the delirium scores is cost-effective for service providers, that the improved quality of results has no additional costs, and that care needs and requirements are lower than with standard treatment. The results are expected by the end of 2020 and should provide the basis for German guidelines on the prevention and management of delirium and POCD, which is often insufficiently defined. Further, they will be entered into the quality contracts of the Institute for Quality Assurance and Transparency in Health Care (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; IQTIG) with the health care insurance providers, thereby improving the quality of treatment for high-risk patients. Finally, the results will make it easier to weigh indications for elective surgery as well as any improvements in quality of life that it might bring.

DOI: 10.3238/arztebl.2019.0373a

PD Dr. med. Christine Thomas
Klinik für Psychiatrie und Psychotherapie für Ältere
Krankenhaus Bad Cannstatt, Klinikum Stuttgart, Germany
c.thomas@klinikum-stuttgart.de

Patricia Sabbah, MA; MSc.
Klinik für Psychiatrie und Psychotherapie für Ältere
Krankenhaus Bad Cannstatt, Klinikum Stuttgart, Germany

Prof. Dr. med. Dr. phil. Michael Rapp
Professur Sozial- und Präventivmedizin, Universität Potsdam, Germany

Prof. Dr. med. Gerhard Eschweiler
Geriatrisches Zentrum Universitätsklinikum Tübingen, Germany

Conflict of interest statement

Prof. Rapp has received consultant honoraria from Lilly, Malteser Deutschland GmbH, and Project GmbH, authorship and lecture fees from Dr. Willmar Schwabe GmbH, lecture fees from the Forum für medizinische Fortbildung FormF GmbH, Akademie Heiligenfeld GmbH, Labor 28 GmbH, Alzheimer Gesellschaft Brandenburg, Wichern Krankenhaus GmbH, DKH Henriettenstiftung GmbH, the Gemeindepsychiatrischen Verbund (Community Mental Health Group), the Altenhilfe GmbH – Friederich von Bodelschwingh Klinik, the Ruppiner Kliniken GmbH, and the Klinikum Quakenbrück.

The remaining authors declare that no conflict of interest exists.

1.
Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R: The perioperative care of older patients—time for a new, interdisciplinary approach. Dtsch Arztebl Int 2019; 116: 63–9 VOLLTEXT
2.
Siddiqi N, Harrison JK, Clegg A, et al.: Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2016; 3: CD005563 CrossRef
4.
Sánchez A, Thomas C, Deeken F, et al.: Patient safety, cost-effectiveness, and quality of life: reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study). Trials 2019; 20: 71 CrossRef MEDLINE PubMed Central
1.Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R: The perioperative care of older patients—time for a new, interdisciplinary approach. Dtsch Arztebl Int 2019; 116: 63–9 VOLLTEXT
2.Siddiqi N, Harrison JK, Clegg A, et al.: Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2016; 3: CD005563 CrossRef
3.Gemeinsamer Bundes­aus­schuss – Innovationsausschuss: PAWEL-Studie https://innovations-fonds.g-ba.de/projekte/versorgungsforschung/pawel-patientensicherheit-wirtschaftlichkeit-und-lebensqualitaet-reduktion-von-delirrisiko-und-postoperativer-kognitiver-dysfunktion-pocd-nach-elektivoperationen-im-alter.16 (last accessed on 26 February 2019).
4.Sánchez A, Thomas C, Deeken F, et al.: Patient safety, cost-effectiveness, and quality of life: reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study). Trials 2019; 20: 71 CrossRef MEDLINE PubMed Central

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