Delirium in older patients with COVID-19

By Sarah MooreReviewed by Emily Henderson, B.Sc.Nov 19 2020

Delirium is common in older patients admitted to US emergency departments with COVID-19 infection, according to the findings of a new study.

Image Credit: Hananeko_Studio/Shutterstock.com

Additionally, patients presenting this symptom were more likely to have poor hospital outcomes or die.

Elderly at greater risk of dying from COVID-19 complications

Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in late December 2019, there have been over 56.3 million confirmed infections and 1.35 million lives lost globally. While people of all ages can contract and become ill with the virus, a growing body of evidence shows that some demographics are at an increased risk of suffering severe symptoms of the disorder, becoming hospitalized, and dying from complications.

Recent data demonstrate that the elderly (those aged 65 or over) is one of these at-risk populations. In the US, those aged 65 or over account for a huge 80% of COVID-19 related deaths. The fact that this age group makes up just 16% of the US population highlights the disproportional representation of the elderly in COVID mortalities.

Delirium is a cognitive symptom characterized by a serious disturbance in mental abilities, resulting in confused thinking and significantly reduced awareness of the environment. Studies have shown that delirium is being increasingly presented by elderly patients admitted to emergency departments.

Unfortunately, research has also highlighted that emergency physicians often fail to recognize and diagnose delirium or fail to recognize the true importance of a diagnosis of delirium.

Since the pandemic was declared in March of 2020, much data has been collected to gain a deeper understanding of the nature of COVID-19 to prevent its transmission and improve the outcomes for those hospitalized with infections.

Previously, anecdotal evidence had suggested that elderly patients present different symptoms to those of the general population when admitted to hospital with COVID-19 infection. Part of this anecdotal evidence hinted that delirium was commonly presented in elderly patients hospitalized with COVID-19.

As delirium is not a common symptom of COVID-19 within the general population, researchers recognized the value of collecting data on its occurrence in the elderly to better understand how COVID-19 impacts this population.

Assessing the frequency of delirium in elderly COVID-19 patients

In a paper published this month in the journal JAMA Network Open, a team of researchers describes how they conducted their study to determine how frequently delirium is presented by older adults hospitalized with COVID-19, and how this impacts their hospital outcomes.

The team collected data from seven sites across the US, assessing a total of 817 patients with a mean age of 77.7 years. Of these patients, 28% presented delirium upon arrival at the hospital.

Additionally, among this group, delirium was the sixth most common symptom of COVID-19 infection. Among those patients diagnosed with delirium, 37% presented no typical COVID-19 symptoms or signs, including fever or shortness of breath.

Enhancing hospital outcomes for elderly COVID-19 patients

The study demonstrates the need to equip emergency staff with the skills to recognize symptoms of delirium in the elderly, particularly in those admitted with COVID-19 infections. It also reveals that symptoms of COVID-19 may differ across populations.

Results showed that it was not uncommon for elderly patients with COVID-19 to display no common symptoms while often presenting with delirium. Moving forward, to enhance hospital outcomes for elderly COVID-19 patients, further studies must be conducted to determine if delirium is preventable in this cohort and what intervention strategies would be effective in protecting the elderly from developing the cognitive syndrome.

Further research is also required to understand how the severity and duration of delirium presented by elderly COVID-19 patients could be reduced.