BACKGROUND: Delirium, an acute confusional state marked by altered consciousness, is commonly observed in elderly inpatients, with its incidence rising with age and prolonged hospitalization. SARS-CoV-2 infection has been linked to delirium and adverse outcomes, including cognitive decline and increased mortality. Given the limited effectiveness of medical interventions on delirium’s severity or duration, primary prevention is crucial. This study aimed to analyze the characteristics of elderly patients admitted to a Geriatrics inpatient unit with COVID-19 and identify specific factors precipitating or predisposing to the development of delirium. METHODS: We conducted a retrospective observational cohort study involving patients aged 65 years or older admitted for COVID-19 in 2022. We examined correlations between delirium and potential precipitating factors (e.g., electrolyte imbalances, inflammatory markers) as well as predisposing factors (e.g., age, sex, comorbid depression and dementia). RESULTS: The study included 212 patients, with a mean age of 82.27 years. The average hospital stay was 24.01 days, with an overall mortality rate of 20.28% and a delirium prevalence of 47.17%. Delirium was more common in older patients (P=0.0010) and those with longer hospital stays (P=0.0003). A history of dementia (OR=65.83, 95%CI 25.52-162.3, P<0.0001) and depression (OR=9.135, 95%CI 4.605-17.19) significantly increased delirium risk. Delirium was also associated with higher mortality (OR=4.975, 95%CI 2.334-10.27, P<0.0001) and elevated sodium levels (P=0.0011). CONCLUSIONS: The findings highlight distinct predisposing (e.g., dementia, depression) and precipitating (e.g., hypernatremia, prolonged hospitalization) factors linked to delirium in elderly COVID-19 inpatients. These insights suggest the need for targeted prevention strategies, including routine screening for cognitive vulnerabilities and early correction of modifiable risk factors, to mitigate the burden of delirium during pandemics and beyond.
Delirium and COVID-19: prevalence, outcomes and associated factors in a cohort of elderly inpatients
FRACCALINI, Thomas;RICCI, Valerio;RIZZO PESCI, Nicola;CARDINALE, Luciano;MAINA, Giuseppe;DI GIOIA, Salvatore;MINNITI, Davide;ROSSO, GianlucaLast
2025-01-01
Abstract
BACKGROUND: Delirium, an acute confusional state marked by altered consciousness, is commonly observed in elderly inpatients, with its incidence rising with age and prolonged hospitalization. SARS-CoV-2 infection has been linked to delirium and adverse outcomes, including cognitive decline and increased mortality. Given the limited effectiveness of medical interventions on delirium’s severity or duration, primary prevention is crucial. This study aimed to analyze the characteristics of elderly patients admitted to a Geriatrics inpatient unit with COVID-19 and identify specific factors precipitating or predisposing to the development of delirium. METHODS: We conducted a retrospective observational cohort study involving patients aged 65 years or older admitted for COVID-19 in 2022. We examined correlations between delirium and potential precipitating factors (e.g., electrolyte imbalances, inflammatory markers) as well as predisposing factors (e.g., age, sex, comorbid depression and dementia). RESULTS: The study included 212 patients, with a mean age of 82.27 years. The average hospital stay was 24.01 days, with an overall mortality rate of 20.28% and a delirium prevalence of 47.17%. Delirium was more common in older patients (P=0.0010) and those with longer hospital stays (P=0.0003). A history of dementia (OR=65.83, 95%CI 25.52-162.3, P<0.0001) and depression (OR=9.135, 95%CI 4.605-17.19) significantly increased delirium risk. Delirium was also associated with higher mortality (OR=4.975, 95%CI 2.334-10.27, P<0.0001) and elevated sodium levels (P=0.0011). CONCLUSIONS: The findings highlight distinct predisposing (e.g., dementia, depression) and precipitating (e.g., hypernatremia, prolonged hospitalization) factors linked to delirium in elderly COVID-19 inpatients. These insights suggest the need for targeted prevention strategies, including routine screening for cognitive vulnerabilities and early correction of modifiable risk factors, to mitigate the burden of delirium during pandemics and beyond.
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