A new study published in the Journal of American Medical Association Network Open indicates that delirium is a frequent symptom among older adults who test positive for COVID-19 when they present in an emergency department.
“Delirium is a common syndrome in older adults; factors associated with risk of delirium amongst COVID-19 positive patients included being over age 75, living in a nursing home or assisted living, prior psychoactive medications use, vision or hearing impairment, stroke, and Parkinson disease,” said Benjamin Helfand, an MD/PhD student at UMass Medical School and co-first author on the study. “Older persons’ immune systems react differently than younger persons, so it’s important that we recognize that presenting symptoms may be different in this population.”
Delirium is defined as an acute change in cognition, altering the way an individual’s brain works. Symptoms may include inattention, disorientation, confusion or hallucination.
The study focused on data from 817 patients from seven emergency departments across the U.S. that were hotspots in the early stages of the pandemic. Participants had different racial and ethnic backgrounds. All patients were adults over age 65 who checked into an ED with COVID-19 on or after March 13. Twenty-eight percent of the patients had delirium on arrival to the ED. Delirium was the sixth most common presenting symptom. The study findings suggest that older adults with the virus often present with delirium in the ED, and that it should be considered an important sign of COVID-19.
“Of the 28 percent of people presenting with delirium, 16 percent had delirium as the primary symptom for coming to the ED, and 37 percent did not include any of the typical COVID-19 symptoms we all hear about, such as fever, coughing or shortness of breath,” said Helfand. “From this study and from these results, we are really striving to raise awareness for providers. While this is an atypical sign of COVID-19, it’s something to consider as we transition into a new phase of the pandemic.”
According to the study, patients with the virus who present with delirium have worse outcomes than those without delirium, including increased likelihood of intensive care unit stays and in-hospital deaths. The study authors seek to alert providers that delirium is an important indicator to identify patients at high risk for poor outcomes, including death.
Researchers said the information will be critical in future studies to evaluate the preventable nature of delirium in COVID-19, and the effectiveness of tested intervention strategies.
“While anyone at any age is susceptible to delirium, individuals over 65 are at higher risk. It is imperative that we give further attention to this group and find ways to isolate their needs and adjust care,” Helfand said.
Maura Kennedy, MD, MPH, division chief of geriatric emergency medicine at Massachusetts General Hospital and assistant professor of emergency medicine at Harvard Medical School, is the co-first author. Tamara Fong, MD, PhD, assistant scientist at the Aging Brain Center of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and assistant professor of neurology at Harvard Medical School, and Sharon Inouye, MD, MPH, director of the Aging Brain Center of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and professor of medicine at Harvard Medical School, are co-senior authors.