The 2019 coronavirus disease (COVID-19) pandemic has wreaked havoc on the world’s older population compared to younger people. Disease characteristics in very old and frail patients appeared to be more severe and different from those in younger age groups. The reasons for this difference in presentation remain unclear.
A recent study published in Geriatric Psychiatry explored what made us think about the risk of delirium in elderly patients hospitalized with COVID-19 and the effects of that hospitalization. The study, conducted as part of the COVID-OLD multicenter cohort study, involved elderly patients. 60 years and older.
It has been reported that one in seven and nearly one in two patients develop delirium when hospitalized with COVID-19 in the general ward. The elderly and other frail people develop this feature more, which serves as a marker of severe illness.
Hospitalized patients are known to be at increased risk of delirium in cases of dementia and/or cognitive impairment if they are very old, need help with life activities, have a history of delirium or other illnesses. The role of fragility as an independent determinant of the threat of delirium in COVID-19 is not yet established.
The approximately 400 patients in this study were hospitalized in the Netherlands between February and May 2020. All were admitted to the non-unusual division, with a median age of 76. The prevalence of delirium at this time was obtained from the Delirium Observation Detection Scale (DOSS), implemented 3 times a day. If the effects were above the specified threshold, a clinical evaluation was also performed through the department physician.
The researchers also looked at the length of hospitalization, such as home discharges or nursing homes and hospital deaths.
Frailty, measured through the Clinical Frailty Scale (CFS), has been used to expect hospital mortality in elderly patients hospitalized with COVID-19. disease and mortality. The question is whether the greatest threat of mortality with delirium is due to the fact that those patients are also more fragile.
The researchers found that 82 of this patient organization developed delirium in their hospitalization episode, or about one in five patients. A previous episode of delirium was associated with an almost 10-fold increased likelihood of delirium this time, while a history of reminiscence of disorders posed almost the same point of risk.
The researchers also found that patients with delirium had a more acute course of the disease, with a shorter duration of symptoms before presenting to the hospital. Their C-reactive protein (CRP) levels were lower at the time of presentation. the symptoms did not differ particularly from those of patients without delirium.
On average, patients with delirium stayed in the hospital longer and required more common nursing care at discharge, as evidenced by the fate of discharge. While one in seven patients with delirium had to stay in a long-term care facility, this happened in one in 3. patients who developed delirium.
However, no significant accumulation of the threat of death was observed in relation to delirium. This is despite the fact that more than a quarter of the cohort died in hospital. This result was reported for almost a portion of patients with delirium, but for one in five patients without delirium.
Risk points for mortality included complex age and increased frailty, but delirium.
The study identified a history of delirium and pre-existing memory disorders as determinants of an increased risk of delirium in the existing episode of covid-19 that warrants hospitalization. However, delirium was not associated with an increased risk of mortality, regardless of frailty.
These findings contrast with some other studies, reflecting the need for additional studies to perceive the extent to which frailty explains the increased threat of death from COVID-19 hospitalization in older adults compared to others. “These effects seem to recommend that the points of threat predisposing to delirium, for example, previous delirium, are rather than precipitating the threat points for delirium, for example, the severity of the disease at presentation, for the threat of delirium in patients with COVID-19.
This shows how important it is to assess the risk of delirium by its risk points in this subgroup of patients. This could help provide preventive measures, which have been shown to reduce the risk of delirium in at-risk patients by 40%. Some treatment would also be done early, which would decrease its severity and duration.
Written By
Dr. Liji Thomas is an obstetrician and gynecologist, graduating from Government Medical College, University of Calicut, Kerala, in 2001. Liji served as a full-time obstetrics/gynecology representative at a personal hospital for a few years after graduating. He praised many patients facing disorders such as pregnancy and infertility, and has had a rate of more than 2,000 deliveries, striving to achieve a general rather than operative delivery.
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Thomas, Liji. (2022, August 31). The prevalence and points for delirium in elderly patients hospitalized with COVID-19. Actualités-Médical. Extracted on September 14, 2022 from https://www. news-medical. net/news/20220831/The-prevalence-and–points-by-delirium-in-elderly-hospitalized-patients-with-COVID-19Arrayaspx.
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