Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

Maria Beatrice Zazzara; Rose S Penfold; Amy L Roberts; Karla A Lee; Hannah Dooley; Carole H Sudre; Carly Welch; Ruth C E Bowyer; Alessia Visconti; Massimo Mangino; Maxim B Freidin; Julia S El-Sayed Moustafa; Kerrin S Small; Benjamin Murray; Marc Modat; Mark S Graham; Jonathan Wolf; Sebastien Ourselin; Finbarr C Martin; Claire J Steves; Mary Ni Lochlainn

doi:10.1093/ageing/afaa223

Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

Maria Beatrice Zazzara, Rose S Penfold, Amy L Roberts, Karla A Lee, Hannah Dooley, Carole H Sudre, Carly Welch, Ruth C E Bowyer, Alessia Visconti, Massimo Mangino, Maxim B Freidin, Julia S El-Sayed Moustafa, Kerrin S Small, Benjamin Murray, Marc Modat, Mark S Graham, Jonathan Wolf, Sebastien Ourselin, Finbarr C Martin, Claire J StevesMary Ni Lochlainn

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.

OBJECTIVE: To assess how frailty affects presenting COVID-19 symptoms in older adults.

DESIGN: Observational cohort study of hospitalised older patients and self-report data for community-based older adults.

SETTING: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.

SUBJECTS: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.

METHODS: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.

RESULTS: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.

CONCLUSIONS: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

Original language	English
Pages (from-to)	40-48
Number of pages	9
Journal	Age and Ageing
Volume	50
Issue number	1
DOIs	https://doi.org/10.1093/ageing/afaa223
Publication status	Published - 8 Jan 2021

Keywords

Aged
COVID-19/epidemiology
COVID-19 Nucleic Acid Testing/methods
Cohort Studies
Delirium/diagnosis
Female
Frail Elderly
Frailty/diagnosis
Geriatric Assessment/methods
Hospitalization/statistics & numerical data
Humans
London/epidemiology
Male
Prevalence
Risk Assessment/methods
Risk Factors
SARS-CoV-2/isolation & purification

Access to Document

10.1093/ageing/afaa223

Cite this

Zazzara, M. B., Penfold, R. S., Roberts, A. L., Lee, K. A., Dooley, H., Sudre, C. H., Welch, C., Bowyer, R. C. E., Visconti, A., Mangino, M., Freidin, M. B., El-Sayed Moustafa, J. S., Small, K. S., Murray, B., Modat, M., Graham, M. S., Wolf, J., Ourselin, S., Martin, F. C., ... Lochlainn, M. N. (2021). Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age and Ageing, 50(1), 40-48. https://doi.org/10.1093/ageing/afaa223

@article{0a2fd3f1beeb46339fe211383e2b2dbb,

title = "Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults",

abstract = "BACKGROUND: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.OBJECTIVE: To assess how frailty affects presenting COVID-19 symptoms in older adults.DESIGN: Observational cohort study of hospitalised older patients and self-report data for community-based older adults.SETTING: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.SUBJECTS: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.METHODS: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.RESULTS: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.CONCLUSIONS: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.",

keywords = "Aged, COVID-19/epidemiology, COVID-19 Nucleic Acid Testing/methods, Cohort Studies, Delirium/diagnosis, Female, Frail Elderly, Frailty/diagnosis, Geriatric Assessment/methods, Hospitalization/statistics & numerical data, Humans, London/epidemiology, Male, Prevalence, Risk Assessment/methods, Risk Factors, SARS-CoV-2/isolation & purification",

author = "Zazzara, {Maria Beatrice} and Penfold, {Rose S} and Roberts, {Amy L} and Lee, {Karla A} and Hannah Dooley and Sudre, {Carole H} and Carly Welch and Bowyer, {Ruth C E} and Alessia Visconti and Massimo Mangino and Freidin, {Maxim B} and {El-Sayed Moustafa}, {Julia S} and Small, {Kerrin S} and Benjamin Murray and Marc Modat and Graham, {Mark S} and Jonathan Wolf and Sebastien Ourselin and Martin, {Finbarr C} and Steves, {Claire J} and Lochlainn, {Mary Ni}",

year = "2021",

month = jan,

day = "8",

doi = "10.1093/ageing/afaa223",

language = "English",

volume = "50",

pages = "40--48",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "1",

}

Zazzara, MB, Penfold, RS, Roberts, AL , Lee, KA, Dooley, H, Sudre, CH, Welch, C, Bowyer, RCE , Visconti, A, Mangino, M, Freidin, MB , El-Sayed Moustafa, JS , Small, KS , Murray, B , Modat, M , Graham, MS, Wolf, J, Ourselin, S , Martin, FC , Steves, CJ & Lochlainn, MN 2021, 'Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults', Age and Ageing, vol. 50, no. 1, pp. 40-48. https://doi.org/10.1093/ageing/afaa223

TY - JOUR

T1 - Probable delirium is a presenting symptom of COVID-19 in frail, older adults

T2 - a cohort study of 322 hospitalised and 535 community-based older adults

AU - Zazzara, Maria Beatrice

AU - Penfold, Rose S

AU - Roberts, Amy L

AU - Lee, Karla A

AU - Dooley, Hannah

AU - Sudre, Carole H

AU - Welch, Carly

AU - Bowyer, Ruth C E

AU - Visconti, Alessia

AU - Mangino, Massimo

AU - Freidin, Maxim B

AU - El-Sayed Moustafa, Julia S

AU - Small, Kerrin S

AU - Murray, Benjamin

AU - Modat, Marc

AU - Graham, Mark S

AU - Wolf, Jonathan

AU - Ourselin, Sebastien

AU - Martin, Finbarr C

AU - Steves, Claire J

AU - Lochlainn, Mary Ni

PY - 2021/1/8

Y1 - 2021/1/8

N2 - BACKGROUND: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.OBJECTIVE: To assess how frailty affects presenting COVID-19 symptoms in older adults.DESIGN: Observational cohort study of hospitalised older patients and self-report data for community-based older adults.SETTING: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.SUBJECTS: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.METHODS: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.RESULTS: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.CONCLUSIONS: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

AB - BACKGROUND: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.OBJECTIVE: To assess how frailty affects presenting COVID-19 symptoms in older adults.DESIGN: Observational cohort study of hospitalised older patients and self-report data for community-based older adults.SETTING: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.SUBJECTS: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.METHODS: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.RESULTS: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.CONCLUSIONS: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

KW - Aged

KW - COVID-19/epidemiology

KW - COVID-19 Nucleic Acid Testing/methods

KW - Cohort Studies

KW - Delirium/diagnosis

KW - Female

KW - Frail Elderly

KW - Frailty/diagnosis

KW - Geriatric Assessment/methods

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - London/epidemiology

KW - Male

KW - Prevalence

KW - Risk Assessment/methods

KW - Risk Factors

KW - SARS-CoV-2/isolation & purification

U2 - 10.1093/ageing/afaa223

DO - 10.1093/ageing/afaa223

M3 - Article

C2 - 32986799

SN - 0002-0729

VL - 50

SP - 40

EP - 48

JO - Age and Ageing

JF - Age and Ageing

IS - 1

ER -

Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults

Abstract

Keywords

Access to Document

Fingerprint

Cite this