Delirium: a missing piece in the COVID-19 pandemic puzzle

O’Hanlon, Shane; Inouye, Sharon K.

doi:10.1093/ageing/afaa094

Cited by 139 publications

(149 citation statements)

References 11 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…This study represents one of the earliest reports on the epidemiology and clinical correlations of delirium in moderate and severe COVID-19. The findings confirm the assumption that delirium is a common complication of hospital stay during the clinical course of COVID-19, especially in older patients with neurologic comorbidities [13]. Thus, diagnosis and adequate management of delirium should be a fundamental part of clinical protocols for the care of patients with moderate or severe forms of COVID-19.…”

Section: Discussionsupporting

confidence: 80%

“…The incidence of delirium in our population was, however, lower (11%) than that predicted for COVID-19 [13] and that previously reported in large multicenter studies conducted in the pre-COVID era in both general medical wards and ICUs (> 20%) [4,20]. There are, however, important fluctuations in the reported incidence of delirium among different clinical settings and populations of hospitalized patients, and an incidence of 11% is similar to that previously reported in a multicenter study of internal medicine wards in Italy [21].…”

Section: Discussioncontrasting

confidence: 78%

“…The older population has been particularly vulnerable to SARS-CoV-2 infection, frequently developing severe forms of COVID-19 with high mortality [11,12]. In spite of this epidemiology, at the moment of writing the association of COVID-19 with delirium has been investigated only sporadically [13], with some anecdotal reports of patients presenting delirium as the first, and sometimes only, sign of COVID-19 [8,14,15]. Thus, the incidence and clinical correlations of delirium during hospital stay for COVID-19 are still poorly known.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital

et al. 2020

View full text Add to dashboard Cite

Background Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. Aim To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. Methods The clinical records of 852 patients admitted for suspect COVID-19 pneumonia, defined as respiratory symptoms or fever or certain history of contact with COVID-19 patients, plus chest CT imaging compatible with alveolar-interstitial pneumonia, were retrospectively analyzed. Delirium was defined after careful revision of daily clinical reports in accordance with the Confusion Assessment Method criteria. Data on age, clinical presentation, comorbidities, drugs, baseline lab tests and outcome were collected. The factors associated with delirium, and the association of delirium with mortality, were evaluated through binary logistic regression models. Results Ninety-four patients (11%) developed delirium during stay. They were older (median age 82, interquartile range, IQR 78–89, vs 75, IQR 63–84, p < 0.001), had more neuropsychiatric comorbidities and worse respiratory exchanges at baseline. At multivariate models, delirium was independently and positively associated with age [odds ratio (OR) 1.093, 95% confidence interval (CI) 1.046–1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204–17.027, p = 0.025), serum urea and lactate-dehydrogenase at admission. Despite a higher mortality in patients with delirium (57% vs 30%), this association was not independent of age and respiratory parameters. Conclusions Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The scoping of newspapers provided an opportunity to capture a more in-depth focus on health and social care teams working in the care of older people. The COVID-19 pandemic disproportionately affects older people [7][8][9]. The scoping review of newspapers found evidence of remarkable efforts by health and social care teams to ensure that older people remained COVID-19 free.…”

Section: Discussionmentioning

confidence: 99%

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Shé

O’Donnell

O’Shea

et al. 2020

IJERPH

View full text Add to dashboard Cite

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.

show abstract

“…In total 57.0% of frail patients experienced new or worsening confusion at some point during their admission episode, either formally diagnosed as delirium or noted as a symptom by the healthcare team caring for the patient. High prevalence of delirium associated with COVID-19 infection has been identi ed in other studies [28] yet local and national guidelines often fail to emphasise the importance of delirium as a potential indicator of COVID-19 illness [32]. Therefore, our ndings on the prevalence of delirium and the range of other presenting features of COVID-19 in older adults, support recommendations which suggest lower thresholds for COVID-19 testing [5] in this population group during periods of signi cant community viral transmission.…”

Section: Discussionmentioning

confidence: 96%

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

Osuafor

Davidson

Mackett

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.

show abstract

Delirium: a missing piece in the COVID-19 pandemic puzzle

Cited by 139 publications

References 11 publications

Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital

Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

Contact Info

Product

Resources

About