TY - JOUR
T1 - Delirium in older patients with COVID-19
T2 - Prevalence, risk factors and clinical outcomes across the first three waves of the pandemic
AU - Minnema, Julia
AU - Tap, Lisanne
AU - van der Bol, Jessica M.
AU - van Deudekom, Floor J. A.
AU - Faes, Miriam C.
AU - Jansen, Steffy W. M.
AU - van der Linden, Carolien M. J.
AU - Lucke, Jacinta A.
AU - Mooijaart, Simon P.
AU - van Munster, Barbara
AU - Noordam, Raymond
AU - van Raaij, Bas F. M.
AU - Ruiter, Rikje
AU - Smits, Rosalinde A. L.
AU - Willems, Hanna C.
AU - Mattace-Raso, Francesco U. S.
AU - Polinder-Bos, Harmke A.
N1 - Funding Information: The Covid‐19 Outcomes in Older People (COOP)‐consortium is a national collaboration in the Netherlands between stakeholders from different care settings (hospitals, primary care practices and nursing homes) and a Seniors Advisory Board (Ouderenraad). In particular, the researchers wish to acknowledge this Seniors Advisory Board (Ouderenraad) for their diverse participation as representatives of older persons and for their helpful feedback and insights throughout the entire project. COOP study group: P. J. M. Elders, Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; J. Festen, KBO‐PCOB, Nieuwegein, the Netherlands; J. Gussekloo, Department of Public Health and Primary Care & Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands; M. van Smeden and K. G. M. Moons, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, the Netherlands; R. J. F. Melis, Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands. This work was supported by Zorg Onderzoek Nederland en Medische Wetenschappen (ZonMw) to the COVID‐19 Outcomes in Older People (COOP) study (project number 10430102110005) under the COVID‐19 programme. ZonMW had no role in data analysis or reporting. Funding Information: The Covid-19 Outcomes in Older People (COOP)-consortium is a national collaboration in the Netherlands between stakeholders from different care settings (hospitals, primary care practices and nursing homes) and a Seniors Advisory Board (Ouderenraad). In particular, the researchers wish to acknowledge this Seniors Advisory Board (Ouderenraad) for their diverse participation as representatives of older persons and for their helpful feedback and insights throughout the entire project. COOP study group: P. J. M. Elders, Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; J. Festen, KBO-PCOB, Nieuwegein, the Netherlands; J. Gussekloo, Department of Public Health and Primary Care & Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands; M. van Smeden and K. G. M. Moons, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, the Netherlands; R. J. F. Melis, Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands. This work was supported by Zorg Onderzoek Nederland en Medische Wetenschappen (ZonMw) to the COVID-19 Outcomes in Older People (COOP) study (project number 10430102110005) under the COVID-19 programme. ZonMW had no role in data analysis or reporting. Publisher Copyright: © 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Objectives: Delirium is a serious condition, which poses treatment challenges during hospitalisation for COVID-19. Improvements in testing, vaccination and treatment might have changed patient characteristics and outcomes through the pandemic. We evaluated whether the prevalence and risk factors for delirium, and the association of delirium with in-hospital mortality changed through the pandemic. Methods: This study was part of the COVID-OLD study in 19 Dutch hospitals including patients ≥70 years in the first (spring 2020), second (autumn 2020) and third wave (autumn 2021). Multivariable logistic regression models were used to study risk factors for delirium, and in-hospital mortality. Differences in effect sizes between waves were studied by including interaction terms between wave and risk factor in logistic regression models. Results: 1540, 884 and 370 patients were included in the first, second and third wave, respectively. Prevalence of delirium in the third wave (12.7%) was significantly lower compared to the first (22.5%) and second wave (23.5%). In multivariable-adjusted analyses, pre-existing memory problems was a consistent risk factor for delirium across waves. Previous delirium was a risk factor for delirium in the first wave (OR 4.02), but not in the second (OR 1.61) and third wave (OR 2.59, p-value interaction-term 0.028). In multivariable-adjusted analyses, delirium was not associated with in-hospital mortality in all waves. Conclusion: Delirium prevalence declined in the third wave, which might be the result of vaccination and improved treatment strategies. Risk factors for delirium remained consistent across waves, although some attenuation was seen in the second wave.
AB - Objectives: Delirium is a serious condition, which poses treatment challenges during hospitalisation for COVID-19. Improvements in testing, vaccination and treatment might have changed patient characteristics and outcomes through the pandemic. We evaluated whether the prevalence and risk factors for delirium, and the association of delirium with in-hospital mortality changed through the pandemic. Methods: This study was part of the COVID-OLD study in 19 Dutch hospitals including patients ≥70 years in the first (spring 2020), second (autumn 2020) and third wave (autumn 2021). Multivariable logistic regression models were used to study risk factors for delirium, and in-hospital mortality. Differences in effect sizes between waves were studied by including interaction terms between wave and risk factor in logistic regression models. Results: 1540, 884 and 370 patients were included in the first, second and third wave, respectively. Prevalence of delirium in the third wave (12.7%) was significantly lower compared to the first (22.5%) and second wave (23.5%). In multivariable-adjusted analyses, pre-existing memory problems was a consistent risk factor for delirium across waves. Previous delirium was a risk factor for delirium in the first wave (OR 4.02), but not in the second (OR 1.61) and third wave (OR 2.59, p-value interaction-term 0.028). In multivariable-adjusted analyses, delirium was not associated with in-hospital mortality in all waves. Conclusion: Delirium prevalence declined in the third wave, which might be the result of vaccination and improved treatment strategies. Risk factors for delirium remained consistent across waves, although some attenuation was seen in the second wave.
KW - COVID-19
KW - SARS-CoV-2
KW - delirium
KW - frailty
KW - metabolic encephalopathy
KW - older adults
UR - http://www.scopus.com/inward/record.url?scp=85175725509&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/gps.6024
DO - https://doi.org/10.1002/gps.6024
M3 - Article
C2 - 37909117
SN - 0885-6230
VL - 38
JO - International journal of geriatric psychiatry
JF - International journal of geriatric psychiatry
IS - 11
M1 - e6024
ER -