Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

Abstract

Background Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, co-morbid adults. Awareness of atypical presentations is critical to facilitate early identification. Objective To assess how frailty affects presenting COVID-19 symptoms in older adults. Design Observational cohort study of hospitalised older patients and self-report data for community-based older adults. Setting Admissions to St Thomas’ Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application. Subjects Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between March 1st, 2020-May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from March 24th (application launch)-May 8th, 2020. Methods Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19. Results Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults, and fatigue and shortness of breath. Conclusions This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

“…However, when our analyses excluded the data from Center 3, which diagnosed delirium exclusively on the basis of physician clinical impression, our results concur with those of three recent studies that found delirium prevalence rates of around 25%. 10,12,13 The observed variability in delirium prevalence between the units participating in our study may be partially explained by differences in physician expertise and methods in delirium detection.…”

“…First of all, it is one of the few multicenter studies 11,25 thus far conducted on delirium in these patients. Previous reports concern studies conducted in a single centers 3,[8][9][10]13,14 and/or in smaller samples. 8,9,13 Moreover, this study also clarifies the factors associated with delirium, which may be helpful for rapid identification of at-risk subjects.…”

Detecting COVID-19 infection hotspots in England using large-scale self-reported data from a mobile application: a prospective, observational study

“…We accounted for some population differences when producing prevalence estimates using specific census adjusted population strata, but the number of invited tests does not allow us to do this when calculating incidence. Differences in reported symptoms across age groups 22 would probably lead to different prediction models of COVID-19 positivity, and the performance of the model will vary with the prevalence of other infections with symptoms that overlap with COVID-19, such as influenza. Furthermore, the app population is less ethnically diverse than the general population.…”

Implementing Delirium Prevention in the Era of COVID-19

“…The prevalence of delirium in inpatient medicine/ surgical units is 15-50% and leads to significant short-term morbidity such as prolonged hospital stays, pressure ulcers, and falls [1][2][3]. Patients with the novel coronavirus (COVID-19) can have multiple neuropsychiatric sequelae including delirium [4][5][6]. The hospitalization of patients with COVID- 19 has revealed additional challenges with delirium Pre-COVID-19, researchers showed us that the etiology for delirium in most cases is multifactorial with specific predisposing risk factors, independent of precipitating factors such as acute incidents or iatrogenic events, increasing the susceptibility for this behavioral presentation [9].…”