Delirium a key sign of COVID-19 in frail, older people

Date:
September 30, 2020
Source:
King's College London
Summary:
A new analysis, using information from the COVID Symptom Study
app and patients admitted to St Thomas' Hospital in London, has
shown that delirium -- a state of acute confusion associated with
a higher risk of serious illness and death -- is a key symptom of
COVID-19 in frail, older people.



FULL STORY ==========================================================================
A new analysis of data from researchers at King's College London using information from the COVID Symptom Study app and patients admitted to St Thomas' Hospital in London, has shown that delirium -- a state of acute confusion associated with a higher risk of serious illness and death --
is a key symptom of COVID-19 in frail, older people.


==========================================================================
The findings, published in the journal Age and Ageing, highlight that
doctors and carers should be aware of delirium as a possible early
warning sign of COVID-19 in the elderly, even in the absence of more
typical symptoms such as cough or fever.

Led by clinical fellow and geriatrician Dr Rose Penfold at King's College London, the researchers analysed data from two groups of older people aged
65 or over from March through May. The first group included 322 patients admitted to hospital with COVID-19 who had tested positive for COVID-19,
while the second comprised 535 users of the COVID Symptom Study app who reported having had a positive test result.

They found that older adults admitted to hospital who were classified
as frail according to a standard scale were more likely to have had
delirium as one of their symptoms than people of the same age who were
not classed as frail.

Delirium, along with tiredness and breathlessness, were also more common
in frailer users of the COVID Symptom Study app with COVID-19, compared
with fitter people of the same age.

A third of app users experiencing delirium did not report suffering the 'classic' COVID-19 symptoms of cough and fever, while delirium was the
only symptom for around one in five (18.9%) of hospitalised patients.

Frailty in the group of hospitalised patients was measured using
the Clinical Frailty Scale (CFS) test, which is administered by a
doctor. COVID Symptom Study App users were asked to complete a short questionnaire asking about their health, which is comparable to the CFS.

This is the first study showing that delirium is a likely symptom
of COVID-19 in frail older adults, although the precise biological
connection between the two conditions still needs to be understood. The findings also highlight the need for systematic assessment of frailty
for older people, along with awareness and screening for delirium for
this vulnerable population in hospitals, care homes and the community.

Dr Rose Penfold from King's College London said: "Older, frailer people
are at greater risk from COVID-19 than those who are fitter, and our
results show that delirium is a key symptom in this group. Doctors
and carers should watch out for any changes in mental state in elderly
people, such as confusion or strange behaviour, and be alert to the fact
that this could be an early sign of coronavirus infection." Dr Claire
Steves from King's College London said: "The past six months have shown
us that COVID-19 can spread catastrophically through care homes. Knowing
that delirium is a symptom in frail, elderly people will help families
and carers spot the signs earlier of COVID-19 and act appropriately
and put in place infection control measures such as isolation,
increased hygiene and personal protective equipment to protect this
highly vulnerable group." Professor Tim Spector, Professor of Genetic Epidemiology at King's College London and COVID Symptom Study lead, said:
"In April we upgraded the COVID Symptom Study app to allow users to log
health reports on behalf of friends and family who aren't able to access
the app. This significantly increased the number of older people in the
study, providing vital insights. We're hugely grateful to all our users
and urge everyone to download the app and log their health and that of
their loved ones on a daily basis as we move towards the winter months."

========================================================================== Story Source: Materials provided by King's_College_London. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. 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 Freydin, Julia S El-Sayed
Moustafa, Kerrin Small, Benjamin Murray, Marc Modat, Jonathan
Wolf, Sebastien Ourselin, Mark S Graham, Finbarr C Martin, Claire
J Steves, Mary Ni Lochlainn. 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,
2020; DOI: 10.1093/ageing/ afaa223 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200930110120.htm

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