WEDNESDAY, Nov. 25, 2020 — For older adults presenting to the emergency department with COVID-19, delirium is common and is associated with worse outcomes, according to a study published online Nov. 19 in JAMA Network Open.
Maura Kennedy, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues conducted a multicenter study at seven U.S. sites to examine how frequently older adults with COVID-19 present to the emergency department with delirium. Data were included for 817 older patients with COVID-19 presenting to the emergency department on or after March 13, 2020.
The researchers found that 28 percent of patients had delirium at presentation; of all presenting symptoms and signs, delirium was the sixth most common. Sixteen percent of patients with delirium had delirium as a primary symptom and 37 percent had no typical signs or symptoms of COVID-19 such as fever or shortness of breath. Age older than 75 years, living in a nursing home or assisted living facility, prior use of psychoactive medication, vision impairment, hearing impairment, stroke, and Parkinson disease were all associated with delirium. There were correlations for delirium with intensive care unit stay and death (adjusted relative risks, 1.67 [95 percent confidence interval, 1.30 to 2.15] and 1.24 [95 percent confidence interval, 1.00 to 1.55], respectively).
“Our study demonstrates that it is critical to recognize that older adults with COVID-19 may present with delirium as the primary or sole symptom,” the authors write. “In addition, delirium is an important risk marker to identify patients at high risk for poor outcomes, including death.”
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