Delirium in Hospitalized Older Adults during the COVID19 Pandemic
References
Lauren Vogel. What’s next now that the WHO has declared a COVID-19 pandemic?. CMAJ 2020;192:E349-E350.
1.Joseph Francis Jr M, MPH. 2020. In: Michael J Aminoff M, DSc, Kenneth E Schmader M, eds. Delirium and acute confusional states: Prevention, treatment, and prognosis. UpToDate.
2.Marcantonio ER. Delirium in Hospitalized Older Adults. New England Journal of Medicine. 2017;377(15):1456-1466.
3.Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242.
Delirium is an acute confusional state characterized by an alteration of consciousness with deficits in attention and is associated with poor outcomes1,2. Older age, dementia, and functional disabilities are predisposing factors, whereas acute illness, drugs, and acute exacerbation of chronic illness are common precipitating factors2. Multicomponent, nonpharmacologic interventions are regularly used to mitigate its risk factors, examples being various re-orientation protocols, cognitive stimulation, early mobilization, amongst others.
With the ongoing Covid19 Pandemic, recent epidemiological studies indicate that middle-aged and older adults are most commonly affected, with older adults being more likely to have severe disease3.
Essential knowledge regarding the treatment of COVID19 is being gained nearly daily. Though the management of the underlying disease remains paramount, older patients remain incredibly vulnerable to develop delirium and its complications. They may require longer hospitalizations, more prolonged ICU stays, while also being kept in isolation. These circumstances make the use of the above-mentioned interventions challenging. Physicians being unable to utilize non-pharmacological alternatives often have to rely on medications like antipsychotics and sedative agents.
Recognition of this potential dilemma is crucial for its prevention. The development of protocols and sharing of knowledge regarding measures used in different inpatient settings may help tackle this obstacle.