In Reply

We thank Prof. Kratz for his important comment. In the meantime, as he showed in his own study (1), the multiprofessional concept has become established in many countries with different healthcare systems. Prof. Kratz is right to point out that in spite of its medical and economic benefit, this concept is not yet refunded or only poorly refunded. However, there are now initiatives such as the quality contracts of the Federal Joint Committee (GBA) for the prevention of postoperative delirium in the care of older patients. Furthermore, in the national dementia strategy passed by the federal government in 2020, dementia in hospital and delirium have a central role.

We agree with Prof. Kratz that currently no funding model exists for the prevention of delirium in hospital. Such medically valuable concepts can sensibly be implemented only if refinancing is undertaken, and not only secondary refinancing as a result of a potential economic benefit. In view of the current financial pressure on health insurance funds as a result of the COVID-19 pandemic, this has not been implemented. For this reason, an initiative for the cost-covering refinancing of delirium management in hospitals should urgently be started.

We have founded a non-profit association, the “Qualitätsgemeinschaft Demenz- Delir-sensibler Versorgungseinrichtungen e.V.” (QDDV, the quality association for dementia-delirium sensitive care organizations, www.qddv.de). Interested parties are welcome to contact us to find a solution for this problem in collaboration with the healthcare institutions and health policy decision makers.

We thank Dr. Rüggeberg and Dr. Nickel for their valuable comments. Dehydration is undoubtedly one of the main causes in the setting of acute geriatric medicine and delirium in older patients.

Unfortunately it is not possible on the basis of our study data to determine whether patients with cognitive deficit were dehydrated (2). In total, 23 of 27 patients (85.2) with delirium from the intervention group and 47 of 77 patients (61%) with delirium in the control group had undergone surgery. It is obviously possible that because of intensive primary nursing in the intervention group, regular fluid administration received attention. But this cannot be determined retrospectively. We thank Dr. Rüggeberg and Dr. Nickel for their important and detailed comments regarding fluid substitution and agree that further studies should be carried out that can be undertaken in routine clinical practice. In the light of current data, however, preoperative fluid abstinence in older patients seems harmful rather than beneficial and should be reconsidered. Dr. Rüggeberg and Dr. Nickel have cited relevant literature in this regard.