Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan 8;50(1):40-48.
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  1   2 , Rose S Penfold  1 , Amy L Roberts  1 , Karla A Lee  1 , Hannah Dooley  1 , Carole H Sudre  3 , Carly Welch  4 , Ruth C E Bowyer  1 , Alessia Visconti  1 , Massimo Mangino  1   5 , Maxim B Freidin  1 , Julia S El-Sayed Moustafa  1 , Kerrin S Small  1 , Benjamin Murray  3 , Marc Modat  3 , Mark S Graham  3 , Jonathan Wolf  6 , Sebastien Ourselin  3 , Finbarr C Martin  7 , Claire J Steves  1 , Mary Ni Lochlainn  1
Affiliations
Observational Study

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 et al. Age Ageing. .

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: COVID-19; delirium; frailty; older people.

PubMed Disclaimer

Conflict of interest statement

The app was developed by Zoe Global Limited with input from King’s College London and Massachusetts General Hospital.

Figures

Figure 1
Figure 1
Baseline characteristics of study population according to frailty in hospitalised and in community-based cohorts (age-matched populations). For all graphs: F, frail subgroup; NF, non-frail subgroup. (a) Mean age (in years), (b) mean BMI (kg/m2) F and NF groups in both sexes combined, female and males, (c) percentage of females in F and NF groups in hospital cohort, (d) mean age (in years), (e) mean BMI (kg/m2) F and NF groups in both sexes combined, female and males, (f) percentage of females in F and NF groups in community-based cohort.
See this image and copyright information in PMC

References

    1. Guan W, Liang W, Zhao Y et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: a Nationwide analysis. Eur Respir J 2000; 55: 547. - PMC - PubMed
    1. Du RH, Liang LR, Yang CQ et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2000; 55: 524. - PMC - PubMed
    1. Wang L, He W, Yu X et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect 2020; 80: 639–45. - PMC - PubMed
    1. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020; 323: 1775–6. - PubMed
    1. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 343–6. - PMC - PubMed

Publication types

MeSH terms