Delirium, a COVID-19 symptom in many older adults, should be part of routine clinical care when people present with COVID-19, according to a recent editorial published in JAMA Insights by Sharon K. Inouye, MD, MPH.
Delirium is a complication of COVID-19 — one that is easily missed and preventable. Delirium in COVID-19 patients has been associated with poor prognosis and increased mortality.
The virus contributes to delirium, but so does the hospital environment. The ban on family members and caregivers is disorienting to older adults as well as socially isolating. Rushed, overstressed staff, wearing full PPE, including face shields and masks, make it difficult for patient to hear or see clinicians. Those with hearing or vision impairments are affected even more. Administration of sedatives and antipsychotics also contribute to delirium.
As a solution, the author references a delirium prevention program established by the American Geriatrics Society Hospital Elder Life Program (HELP). The program includes a host of interventions, including in-room communication boards, bedside activities (eg, crossword puzzles), sleep aids (eg, ear plugs, sleep masks) and facilitation of remote visits from friends, family and caregivers.
“Nonpharmacologic multicomponent strategies remain the mainstay of prevention and management, and finding creative ways to build a ‘new normal’ for care of older adults will be essential,” the author concluded.
“Approaches involving family members — remotely or with careful in-person visits — will be critical to provide comfort, communication, and connection for older adults. Families should be involved as part of the caregiving team to enhance both short-term and long-term outcomes of delirium for this vulnerable population.”
Inouye SK. The Importance of Delirium and Delirium Prevention in Older Adults During Lockdowns. JAMA Insights. Published online March 15, 2021. doi: 10.1001/jama.2021.2211.