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In-Hospital Delirium and Disability and Cognitive Impairment After COVID-19 Hospitalization

Abstract

Importance: Older adults who are hospitalized for COVID-19 are at risk of delirium. Little is known about the association of in-hospital delirium with functional and cognitive outcomes among older adults who have survived a COVID-19 hospitalization.

Objective: To evaluate the association of delirium with functional disability and cognitive impairment over the 6 months after discharge among older adults hospitalized with COVID-19.

Design, Setting, And Participants: This prospective cohort study involved patients aged 60 years or older who were hospitalized with COVID-19 between June 18, 2020, and June 30, 2021, at 5 hospitals in a major tertiary care system in the US. Follow-up occurred through January 11, 2022. Data analysis was performed from December 2022 to February 2024.

Exposure: Delirium during the COVID-19 hospitalization was assessed using the Chart-based Delirium Identification Instrument (CHART-DEL) and CHART-DEL-ICU.

Main Outcomes And Measures: Primary outcomes were disability in 15 functional activities and the presence of cognitive impairment (defined as Montreal Cognitive Assessment score <22) at 1, 3, and 6 months after hospital discharge. The associations of in-hospital delirium with functional disability and cognitive impairment were evaluated using zero-inflated negative binominal and logistic regression models, respectively, with adjustment for age, month of follow-up, and baseline (before COVID-19) measures of the respective outcome.

Results: The cohort included 311 older adults (mean [SD] age, 71.3 [8.5] years; 163 female [52.4%]) who survived COVID-19 hospitalization. In the functional disability sample of 311 participants, 49 participants (15.8%) experienced in-hospital delirium. In the cognition sample of 271 participants, 31 (11.4%) experienced in-hospital delirium. In-hospital delirium was associated with both increased functional disability (rate ratio, 1.32; 95% CI, 1.05-1.66) and increased cognitive impairment (odds ratio, 2.48; 95% CI, 1.38-4.82) over the 6 months after discharge from the COVID-19 hospitalization.

Conclusions And Relevance: In this cohort study of 311 hospitalized older adults with COVID-19, in-hospital delirium was associated with increased functional disability and cognitive impairment over the 6 months following discharge. Older survivors of a COVID-19 hospitalization who experience in-hospital delirium should be assessed for disability and cognitive impairment during postdischarge follow-up.

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References
1.
Wong A, Black S, Yiu S, Au L, Lau A, Soo Y . Converting MMSE to MoCA and MoCA 5-minute protocol in an educationally heterogeneous sample with stroke or transient ischemic attack. Int J Geriatr Psychiatry. 2018; 33(5):729-734. DOI: 10.1002/gps.4846. View

2.
Ferrucci R, Dini M, Rosci C, Capozza A, Groppo E, Reitano M . One-year cognitive follow-up of COVID-19 hospitalized patients. Eur J Neurol. 2022; 29(7):2006-2014. PMC: 9111730. DOI: 10.1111/ene.15324. View

3.
Rebora P, Rozzini R, Bianchetti A, Blangiardo P, Marchegiani A, Piazzoli A . Delirium in Patients with SARS-CoV-2 Infection: A Multicenter Study. J Am Geriatr Soc. 2021; 69(2):293-299. PMC: 7753490. DOI: 10.1111/jgs.16969. View

4.
Jones A, Trzeciak S, Kline J . The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009; 37(5):1649-54. PMC: 2703722. DOI: 10.1097/CCM.0b013e31819def97. View

5.
Hshieh T, Inouye S, Oh E . Delirium in the Elderly. Clin Geriatr Med. 2020; 36(2):183-199. DOI: 10.1016/j.cger.2019.11.001. View