The impact of delirium on outcomes for older adults hospitalised with COVID-19

• Published in: Age and ageing Vol. 49; no. 6; pp. 923 - 926
• Main Authors: Marengoni, Alessandra, Zucchelli, Alberto, Grande, Giulia, Fratiglioni, Laura, Rizzuto, Debora
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2020; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Betacoronavirus; Causality; Central nervous system; Chemical analysis; Chronic illnesses; Comorbidity; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Delirium; Delirium - epidemiology; Diagnostic and Statistical Manual; Female; Frailty - epidemiology; Geriatricians; Hospital Mortality; Hospitalization; Hospitals - statistics & numerical data; Humans; Incidence; Intensive care; Italy - epidemiology; Male; Medical diagnosis; Medical prognosis; Mental disorders; Mortality; Nervous system; Older people; Pandemics; Patients; Pharynx; Pneumonia, Viral - epidemiology; Polymerase chain reaction; Retrospective Studies; Ribonucleic acid; RNA; RNA-directed DNA polymerase; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Short Report; Italy; COVID-19; older people; delirium
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afaa189

Introduction Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the Diagnostic and Statistical Manual of Mental Disorders V (DMS V) criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.