November 23, 2020 -- Delirium or confusion could be an early warning signal of COVID-19 in older adults, according to a new study published in the journal JAMA Network Open.
More than a quarter of patients over age 65 arrived at the emergency room with delirium, and more than a third didn’t have typical COVID-19 symptoms such as a cough or a fever.
“One of our main messages, especially right now, is to really try to screen everyone, older adults especially,” Benjamin Helfand, one of the study authors and a doctoral candidate at the University of Massachusetts Medical School, told STAT News.
Delirium -- or confusion, disorientation, inattention, and other cognitive changes -- can be a common sign of infection in older adults, who have immune systems that respond in different ways to viruses and bacteria than younger adults.
So far this year, delirium has been identified as a less common symptom of COVID-19, but it may show up more often in older adults and those who have a severe form of the disease or need a ventilator to breathe. In general, patients with delirium from any illness tend to stay in the hospital longer and are more likely to die, STAT reported.
“Delirium is a great barometer,” Wes Ely, MD, a critical care doctor at Vanderbilt University, told STAT. “If people are confused, pay attention, because right now, they could have COVID.”
In the study, researchers analyzed medical records for 817 COVID-19 patients at seven hospitals across five states when the pandemic surged in mid-March. All the patients were 65 and older, and the average age was 77.
More than 28% were diagnosed with delirium, which was the sixth most common symptom after fever, shortness of breath, low oxygen, coughing, and weakness. At the same time, more than 37% of those with delirium reported none of the other common COVID-19 symptoms, and 16% had delirium as a primary symptom.
Those with delirium were more likely to be over age 75, live in a nursing home or assisted living facility, have Parkinson’s disease, have taken psychoactive medication in the past, and have vision or hearing problems.
Even still, most emergency departments don’t screen patients for delirium as part of their routine, STAT reported. But the study authors hope their research will prompt people to be aware and treat it earlier.
“Adding delirium as a common presenting symptom of Covid-19 will keep important cases from being missed and allow earlier identification and management of vulnerable patients at high risk for poor outcomes,” they wrote.