Older adults who experienced delirium while hospitalized for COVID-19 showed increases in functional disability and cognitive impairment in the six months following their discharge, according to a prospective cohort study.
In this study, conducted among older patients hospitalized for COVID-19 early in the pandemic, those who had delirium exhibited higher rates of functional disability (rate ratio 1.32, 95% CI 1.05-1.66) and cognitive impairment (odds ratio 2.48, 95% CI 1.38-4.82) over the six months post-discharge compared to those who did not experience in-hospital delirium.
Among the 311 individuals included in the functional disability analysis, 15.8% experienced in-hospital delirium. In the cognition subset of 271 patients, 11.4% had delirium during their hospital stay.
“Older adults continue to be hospitalized with COVID-19 throughout the year, and many experience delirium during that hospitalization, yet they are not routinely screened for functional and cognitive impairment after discharge,” Ferrante stated in an email to MedPage Today.
“Older survivors of a COVID hospitalization who experience in-hospital delirium should be evaluated for functional and cognitive impairment soon after discharge and referred for physical and cognitive rehabilitation early,” she emphasized.
Among patients with in-hospital delirium, the unadjusted mean disability count rose from 4 disabilities prior to hospitalization to 6.6 disabilities one month after discharge, subsequently decreasing to 5.3 disabilities at six months post-discharge.
For those without in-hospital delirium, the mean number of disabilities was 1.8 before hospitalization, increasing to 2.7 at one month after discharge, and then declining to 2.1 disabilities at six months.
Before hospitalization, 9.7% of patients who developed in-hospital delirium had cognitive impairment, compared to 2.9% of those without delirium. At six months, cognitive impairment was reported in 34.8% of the delirium group versus 20.7% in the non-delirium group.
This study is not the first to link delirium during COVID-19 hospitalization with adverse outcomes. A Brazilian study identified a correlation between cognitive impairment and factors such as higher age, lower education, and delirium following hospitalization for severe COVID in 2020.
“Many established delirium prevention efforts were disrupted during the height of the pandemic,” Ferrante remarked. She noted that even now, delirium prevention protocols are not consistently implemented for COVID patients.
“Our study calls for a renewed focus on delirium prevention efforts,” she added. This includes engaging families, encouraging early mobilization, addressing hearing and vision impairments, providing frequent orientation, implementing nonpharmacologic sleep preservation strategies, and avoiding sedating medications that may trigger delirium.
The research involved 311 adults aged 60 and older who were hospitalized for COVID-19 from June 2020 to June 2021 at five major tertiary hospitals in the U.S.
The average age was approximately 71 years, and 52.4% of the participants were female. More than one-third of the cohort consisted of individuals from minority racial and ethnic groups. Of the 311 participants, 271 were included in the cognition sample due to missing data.
Researchers assessed disability through basic and instrumental activities of daily living, along with three mobility activities.
The Montreal Cognitive Assessment 5-minute protocol was utilized to evaluate cognitive function. Assessments were conducted one, three, and six months after hospital discharge.
One limitation of the study is that researchers depended on electronic medical records to determine baseline cognitive impairment instead of clinical evaluations, which may have resulted in missed cases.
Additionally, the cohort might not have included the most critically ill patients, potentially leading to a bias towards a healthier population. The participants were enrolled before widespread COVID-19 vaccination, leaving uncertainty regarding the impact of vaccination on outcomes, the authors noted.
