This story is part of a series about founders and experts discovered during the Frontiers Health’s event in Berlin (Germany), where innovative healthcare professionals and disruptive entrepreneurs presented their products, services and ideas. Got a story to tell? Let us know! Email us at [email protected].

Delirium is emerging as one of the most dangerous and costly complications in modern hospitals, yet it remains largely invisible to the public and underestimated by health systems. Entrepreneur John Klepper, a healthcare founder working at the intersection of neuroscience and AI, is sounding the alarm on this hidden epidemic and building tools to stop it before it starts.​​

What Is Delirium and Why It Matters

In clinical terms, delirium is an acute disturbance in attention and cognition that often appears suddenly during a hospital stay, especially after surgery or trauma. While it can affect patients of all ages, it is particularly prevalent in people over 60, where as many as one in four older patients admitted to hospital will experience delirium at some point in their stay. Despite this, around 70% of symptomatic delirium cases go undiagnosed, meaning millions of patients are discharged without anyone ever naming what happened to them.

The consequences of undetected delirium can be devastating. A patient may enter hospital cognitively sharp for something as routine as a knee or hip surgery and leave with serious cognitive complications. Instead of returning home, they are suddenly routed into long‑term care, with their risk of nursing home admission and subsequent dementia significantly increased. For families, it feels like an overnight transformation; for health systems, it quietly drives up costs through longer hospital stays, more complications and higher readmission rates.​​

Why Delirium Gets Missed So Often

According to John Klepper, delirium is;

“massively underserved and underrecognised!”

Mainly because it is still widely viewed as a temporary side effect rather than a disease in its own right. In many hospitals, diagnosing delirium is a slow, manual process that requires a senior specialist—often a neuropsychiatrist—to visit the bedside, ask extensive questions and make a call. With stretched staff and crowded wards, this ideal workflow rarely happens consistently.​

There is another, more insidious problem: hypoactive delirium. Unlike hyperactive delirium, where patients may shout, hallucinate or try to escape, hypoactive patients appear quiet, compliant and still. They might be in severe pain, dehydrated or profoundly confused, but because they are not disruptive, their delirium goes unnoticed while complications accumulate in the background. When these patients fall, develop infections, suffer pressure ulcers or later show rapid cognitive decline at home, the underlying delirium often never makes it into the medical record.​

John Klepper’s Mission: Turning a Personal Story into Systemic Change

For John Klepper, the fight against delirium is not just an abstract clinical problem—it is deeply personal. His own mother experienced severe delirium during a hospital stay, spending days convinced that staff were trying to kill her. She eventually recovered, but the trauma of that episode left her unwilling to go near a hospital again, a reaction that many families will recognise.​​

Klepper is a serial entrepreneur with previous exits in other industries who has spent the past eight years focused on healthcare, particularly in neuroscience and AI. He is driven, as he puts it, by impact: the desire to improve and save lives, especially in populations that are underserved. Older patients over 60, who face the highest risk of delirium yet often receive less attention than younger cohorts, have become the central focus of his work.​​

Pipra: Using AI to Predict and Prevent Delirium

To tackle the problem at scale, John Klepper co‑founded Zurich‑based Pipra AG alongside Nayeli Schmutz and Benjamin Dodsworth, which has developed an AI‑powered, CE‑certified preoperative risk assessment tool for delirium. Rather than waiting for confusion to appear on the ward, Pipra’s software analyses routinely collected clinical data before surgery and generates an individual delirium risk score for each patient.

This allows hospitals to identify high‑risk patients early and apply targeted preventive measures instead of blanket, resource‑intensive protocols. In practice, that means better hydration, careful pain management, orienting the patient regularly, involving families and optimising medication and environment for those most at risk of delirium. Studies and health‑economic models suggest that screening 1,000 patients with such tools and prevention pathways can save around 2.5 million euros through shorter length of stay, fewer complications and reduced readmissions.​

For payers and providers, the value proposition goes beyond compassion—it is about hard numbers. Delirium drives up the length of hospital stays, requires more nursing hours, causes falls and infections and increases the likelihood that a patient is discharged directly to a nursing home. These knock‑on effects make delirium more expensive to the US healthcare system than diabetes, even though diabetes receives far more attention and resources.​​

Delirium Is Not a Rare Disease

One of the myths John Klepper wants to dispel is that delirium is rare or niche. In reality, it affects an estimated 60 million people globally every year, with incidence expected to rise as populations age. What makes it appear rare is not the numbers but the under‑diagnosis and mis‑classification: delirium cases are recorded as falls, hip fractures, infections or dementia, while the root cause never appears in official statistics.​​

Klepper argues that any hospital that is not actively tracking and managing delirium is also ignoring a major driver of costs and poor outcomes. When hospitals choose to focus on delirium prevention, they simultaneously reduce falls, infections, pressure ulcers, readmission rates and extended length of stay—metrics that also influence their public ratings and financial performance. That is why he sees delirium as one of the biggest unaddressed opportunities in healthcare today.​​

A Call to Hospitals, Investors and Founders

For hospital leaders and policymakers, the message from John Klepper is clear: if delirium is not already on the list of strategic priorities, it should be. Modern, prevention‑minded institutions are beginning to implement structured delirium risk assessment and management as part of standard care, supported by digital tools like Pipra’s AI‑driven platform. Those that fail to adapt risk higher costs, worse outcomes and growing scrutiny as awareness of delirium spreads.​​

For investors, delirium represents a sector that is “massively underserved, but not for long,” in Klepper’s words. As evidence builds and reimbursement frameworks evolve, technologies that accurately predict and help prevent delirium are positioned to become critical infrastructure inside hospitals. Backing founders who understand both the clinical reality and the economic incentives—like John Klepper—offers a chance to participate in building a safer, more sustainable model of perioperative care.​

What Families and Founders Can Do Right Now

Klepper’s advice is not only for health systems and investors, but also for founders and families who may soon find themselves navigating hospital care. If a relative or friend over 60 is going into hospital, he urges people to learn about delirium in advance and actively ask the hospital what they are doing to prevent it. Questions about risk screening, staff training and preventive measures can prompt clinicians to take delirium more seriously in individual cases.​

If the answers suggest that delirium is not on the radar, Klepper recommends considering another hospital that is more proactive. For entrepreneurs in healthcare, his message is to look hard at neglected, high‑impact problems like delirium and build solutions that combine clinical evidence, AI and usability to fit into everyday workflows. In his view, the future of hospital care will be defined not just by the surgeries performed, but by how well the system protects the minds of the people who undergo them.

This article was brought to you by Frontiers Health, which is one of the premier global health innovation events, with a strong focus on digital therapies, breakthrough technologies, healthcare transformation, investments, and ecosystem development. Frontiers Health is hosted and powered by EVERSANA.​

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