RT Journal Article
SR Electronic
T1 Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E692
OP E701
DO 10.9778/cmajo.20210176
VO 10
IS 3
A1 Eric Kai-Chung Wong
A1 Jennifer Watt
A1 Hanyan Zou
A1 Arthana Chandraraj
A1 Alissa Wenyue Zhang
A1 Jahnel Brookes
A1 Ashley Verduyn
A1 Anna Berall
A1 Richard Norman
A1 Katrina Lynn Piggott
A1 Terumi Izukawa
A1 Sharon E. Straus
A1 Barbara Liu
YR 2022
UL http://www.cmajopen.ca/content/10/3/E692.abstract
AB Background: The COVID-19 pandemic has affected older adults disproportionately, and delirium is a concerning consequence; however, the relationship between delirium and corticosteroid use is uncertain. The objective of the present study was to describe patient characteristics, treatments and outcomes among older adults hospitalized with COVID-19, with a focus on dexamethasone use and delirium incidence.Methods: We completed this retrospective cohort study at 7 sites (including acute care, rehabilitation and long-term care settings) in Toronto, Ontario, Canada. We included adults aged 65 years or older, consecutively hospitalized with confirmed SARS-CoV-2 infection, between Mar. 11, 2020, and Apr. 30, 2021. We abstracted patient characteristics and outcomes from charts and analyzed them descriptively. We used a logistic regression model to determine the association between dexamethasone use and delirium incidence.Results: During the study period, 927 patients were admitted to the acute care hospitals with COVID-19. Patients’ median age was 79.0 years (interquartile range [IQR] 72.0–87.0), and 417 (45.0%) were female. Most patients were frail (61.9%), based on a Clinical Frailty Scale score of 5 or greater. The prevalence of delirium was 53.6%, and the incidence was 33.1%. Use of restraints was documented in 20.4% of patients. In rehabilitation and long-term care settings (n = 115), patients’ median age was 86.0 years (IQR 78.5–91.0), 72 (62.6%) were female and delirium occurred in 17 patients (14.8%). In patients admitted to acute care during wave 2 of the pandemic (Aug. 1, 2020, to Feb. 20, 2021), dexamethasone use had a nonsignificant association with delirium incidence (adjusted odds ratio 1.38, 95% confidence interval 0.77–2.50). Overall, in-hospital death occurred in 262 (28.4%) patients in acute care settings and 28 (24.3%) patients in rehabilitation or long-term care settings.Interpretation: In-hospital death, delirium and use of restraints were common in older adults admitted to hospital with COVID-19. Further research should be directed to improving the quality of care for this population with known vulnerabilities during continued waves of the COVID-19 pandemic.