The elderly form one of the most vulnerable groups severely affected by the COVID-19 pandemic. A vast number of casualties has been reported among older adults. Timely identification of symptoms can protect them from adverse outcomes. Now, scientists from King's College London have found that delirium—a state of severe confusion—is an important symptom of the novel coronavirus infection in frail, older people.
According to the study, hospitalized older adults who were classified as frail were at an increased likeliness of having delirium as one of their symptoms in comparison to those of the same age who were not considered frail. "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," said Dr. Rose Penfold, co-author of the study, in a statement.
Measuring Frailty Among the Elderly
For the study, the authors analyzed data collected from two groups of older adults aged 65 or above, between March and May. 322 patients hospitalized due to testing positive for COVID-19 formed the first group. The second group was constituted by 535 users of the 'COVID Symptom Study' app, who had also reported testing positive for the disease.
The frailty among the hospitalized patients was measured through the Clinical Frailty Scale (CFS) test that was administered by a physician. The users of the app were required to answer a short questionnaire regarding their health, which could be compared to the CFS.
Delirium—A Silent Symptom
The researchers found that along with breathlessness and tiredness, delirium was common among frailer users of the app with COVID-19 when compared to fitter individuals within the same age group. Interestingly, a third of the app users who suffered from delirium did not report suffering from any of the 'classic' symptoms of the disease such as fever and cough. Delirium was also the only symptom in one in five or 18.9 percent of hospitalized patients.
"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," explained Prof. Tim Spector, co-author of the study.
Need to Screen and Evaluate for Delirium
While the study shows delirium as a likely symptom of the coronavirus infection, the exact biological relationship between the two conditions requires further understanding, the authors admitted. However, the study emphasizes the need for systematically evaluating frailty in older people, in addition to bringing awareness to screening for delirium among this vulnerable population at health care facilities and home.
"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," concluded Dr. Claire Steves, co-author of the study.