Delirium in Older People with COVID-19: Clinical Scenario and Literature Review
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COVID-19
Delirium in Older People with COVID-19: Clinical Scenario and Literature Review Demelza Emmerton 1 & Ahmed Abdelhafiz 1 Accepted: 20 August 2020 # Springer Nature Switzerland AG 2020
Abstract Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality. The new SARS-CoV-2 shows, not only pulmonary tropism but also, neurotropism which results in delirium in the acute phase illness particularly in the older age groups. The current assessment for COVID-19 in older people does not routinely include screening for delirium. Implementation of a rapid delirium screening tool is necessary because, without screening, up to 75% of cases can be missed. Delirium can also be exaggerated by health care policies that recommend social isolation and wearing personal protective equipment in addition to less interaction with patients. Non-pharmacological intervention for delirium prevention and management may be helpful if implemented as early and as often as possible in hospitalised older people with COVID-19. A holistic approach that includes psychological support in addition to medical care is needed for older people admitted to hospital with COVID-19. Keywords Older people . Delirium . COVID-19 . Hospitalised . Management
Introduction The respiratory disease COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was initially reported in Wuhan, Hubei province, China. [1] The disease has since spread across the continents to become a global pandemic. The SARS-CoV-2 is a zoonotic virus similar to the previous corona viruses that caused the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS). The COVID-19 spreads rapidly by human-to-human transmission, primarily through respiratory droplets, physical contact and via fomites. [2] COVID-19 typically presents with fever, myalgia, fatigue and dyspnoea or with less common symptoms such as nausea, vomiting, diarrhoea, abdominal pain and headache. [2] It has a fatality rate of 2.3% across all age groups, with 14.8% in patients ≥ 80 years old and 8.0% in those 70–79 of age reported. [3] Mortality was found to be higher in
patients with pre-existing comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease and cancer. [3] In addition to the typical presentation of COVID-19, acute brain dysfunction, symptomatically presenting as delirium, may be a feature of the neuro-invasive potential of the SARS-CoV-2 virus. Neuro-tropic properties of the corona viruses have been previously demonstrated. Older people affected by the SARS epidemic in 2003 presented not only with respiratory symptoms but also with general decline and delirium. [4] Because of the similarities in the pathogenicity of the SARS-Co
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