Delirium symptoms duration and mortality in SARS-COV2 elderly: results of a multicenter retrospective cohort study

Morandi, Alessandro; Rebora, Paola; Isaia, Gianluca; Grossi, Eleonora; Faraci, B.; Gentile, Simona; Bo, Mario; Valsecchi, Maria Grazia; Deiana, Valentina; Ghezzi, Nives; Miksza, Julia; Blangiardo, Paolo; Bellelli, Giuseppe

doi:10.1007/s40520-021-01899-8

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…We found that a combination of high-risk NSS and the absence of low-risk NSS, increased the risk of in-hospital death nearly 8-fold in patients with SARS-CoV-2 infection. It was previously noted that isolated neurological symptoms, such as decreased level of consciousness [ 32 ], delirium [ 33 ], or stroke symptoms [ 34 ], were associated with increased mortality in COVID-19 patients. The latest literature review showed that any neurological manifestation of SARS-CoV-2 infection was correlated with a higher mortality rate [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

et al. 2022

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We aimed to search whether neurological symptoms or signs (NSS) and the MEWS (Modified Early Warning Score) score were associated with in-hospital mortality or oxygen requirement during the first 14 days of hospitalization in COVID-19 patients recruited at the University Hospital in Krakow, Poland. The detailed clinical questionnaires on twenty NSS were either filled out by patients prospectively or retrospectively assessed by neurologists based on daily medical records. NSS were considered high or low-risk if they were associated with increased or decreased mortality in the univariable analysis. This cohort study included 349 patients with COVID-19 (median age 64, interquartile range (51–77), women 54.72%). The presence of high-risk NSS (decreased level of consciousness, delirium, seizures, and symptoms of stroke or transient ischemic attack) or its combination with the absence of low-risk NSS (headache, dizziness, decreased mood, and fatigue) increased the risk of in-hospital mortality in SARS-CoV-2 infection 3.13 and 7.67-fold, respectively. The presence of low-risk NSS decreased the risk of in-hospital mortality in COVID-19 patients more than 6-fold. Death in patients with SARS-CoV-2 infection, apart from NSS, was predicted by older age, neoplasm, and higher MEWS scores on admission. High-risk NSS or their combination with the absence of low-risk NSS increased the risk of oxygen requirement during hospitalization in COVID-19 patients 4.48 and 1.86-fold, respectively. Independent predictors of oxygen therapy during hospitalization in patients with SARS-CoV-2 infection were also older age, male sex, neoplasm, and higher MEWS score on admission.

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Section: Discussionmentioning

confidence: 99%

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

et al. 2022

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“…Among other variables such as comorbidities and severity of the underlying disease, the duration of delirium is associated with adverse consequences [ 22 – 22 ]. Morandi et al described a 10% increase in in-hospital mortality among older SARS-CoV2 patients with each day with delirium [ 21 ]. Therefore, non-pharmacological delirium interventions play a vital role in delirium management.…”

Section: Discussionmentioning

confidence: 99%

PAINT I: the effect of art therapy in preventing and managing delirium among hospitalized older adults in the PAINT I study—a proof-of-concept trial

et al. 2022

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Key Summary Points Aim The aim of the study was to determine the effectiveness of art therapy as prevention and therapeutical approach in geriatric patients with high risk for delirium. Findings The study was not able to prove the hypothesis that a specific art therapy intervention was able to prevent delirium in patients of an acute geriatric ward, but it seemed to have a positive effect on the duration of delirium. No adverse events were registered in relation to art therapy. Message Art therapy might be an innovative additional non-pharmacological approach in the management of delirium. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00695-5.

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“…Sub-acute care, often defined as care for older patients with decompensated well-known chronic conditions, represent expanding healthcare services to face the increase of comorbidity and complex healthcare and social needs, and might be included into the broad category of intermediate care resources [ 12 , 18 ]. During the pandemic, these services have been predisposed to care for COVID-19 older patients as a complement to the insufficient acute hospital capacity for selected acute patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review reported a high prevalence and incidence of delirium in older patients with COVID-19 in acutely hospitalized patients [ 8 ]. However, only a few studies were conducted in rehabilitation and nursing homes [ 4 , 5 ]. Moreover, several studies have focused on the association between delirium and mortality in COVID-19, but little is known about the relationship between delirium and functional performances [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several factors have been associated with adverse outcomes in older persons including age, the severity of the acute illness, frailty, delirium, and dementia [ 2 , 3 ]. Few data have been published on the management and effects of COVID-19 in rehabilitation wards and nursing home [ 4 , 5 ], even though these settings represented complementary alternatives to conventional acute hospitalizations in many cases [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Geriatric syndromes and functions in older adults with COVID-19 hospitalized in sub-acute care: a multicenter study

et al. 2022

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Objective Alternatives to conventional acute hospitalizations have been particularly useful during the COVID-19 pandemic. However, little is known on the management and outcomes of COVID-19 in older patient admitted to non-acute settings. The main aim of this study was to determine the effect of geriatrics syndromes on functional outcomes in older COVID-19 patients cared in sub-acute units. Methods Prospective multicenter observational cohort study of patients aged 65 years and older with COVID-19, admitted to sub-acute units in Italy and Spain. Multivariable logistic regression models were used to test the association between geriatric syndromes and other clinical variables, and the functional status at discharge, defined by a Barthel Index > = 80. Results A total of 158 patients were included in the study with a median age of 82 [Interquartile Range 81, 83]; of these 102 (65%) patients had a Barthel Index ≥ 80 at discharge. In the main multivariable logistic regression model a higher severity of frailty-measured with the Clinical Frailty Scale—(OR 0.30; CI 0.18–0.47), and the presence of delirium (OR 0.04; CI 0.00–0.35) at admission were associated with lower odds of a higher functional status at discharge. Other variables associated with lower functional status were female gender (OR 0.36; CI 0.13–0.96), and a higher number of comorbidities (OR 0.48; CI 0.26–0.82). Conclusion The study reports a relatively high prevalence of functional recovery for older COVID-19 patients admitted to sub-acute units. Additionally, it underlines the importance of targeting geriatrics syndromes, in particular frailty and delirium, for their possible effects on functional recovery.

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Delirium symptoms duration and mortality in SARS-COV2 elderly: results of a multicenter retrospective cohort study

Cited by 9 publications

References 29 publications

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

PAINT I: the effect of art therapy in preventing and managing delirium among hospitalized older adults in the PAINT I study—a proof-of-concept trial

Geriatric syndromes and functions in older adults with COVID-19 hospitalized in sub-acute care: a multicenter study

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