Image of Sharon Inouye, M.D., MPH

Steps must be taken to detect and address delirium due to COVID-19 in older adults — and not only in severe cases, according to a leading eldercare physician and researcher.

Delirium is not included in federal case report criteria for COVID-19, but the condition is a well-recognized complication of the disease and sometimes is the only presenting sign. It also is easily missed by clinicians despite often being preventable and reversible, wrote Sharon Inouye, M.D., MPH, of Hebrew SeniorLife and Harvard Medical School, in a JAMA Insights article published Monday. 

The ability to recognize and manage this condition in COVID-19 cases will directly affect clinical outcomes in adults aged 65 years and older as the pandemic continues, Inouye contended. 

“The first and most important step in management of delirium is its recognition,” she wrote. “All older patients with suspected COVID-19 infection should be screened for delirium, because atypical presentations are typical in all older adults and because delirium is the sixth most common presenting symptom in older adults with COVID-19.”

Many brief, convenient screening instruments are available and can help healthcare providers detect the condition before it has escalated, Inouye wrote. The Ultra-Brief Confusion Assessment Method, for example, can be completed in less than one minute in high-risk settings for older adults, including nursing homes, she notes.

Many of the factors that contribute to delirium are reversible, and Inouye recommended that once the condition is diagnosed, clinicians should focus on creative, nonpharmacologic multicomponent strategies for prevention and management. Hospital delirium prevention programs, such as the Hospital Elder Life Program, or HELP, can be used for this purpose, she said.

A key component of delirium prevention is family member involvement, whether remotely or in person, Inouye writes. The HELP program, for example, recommends providing activities with family or trained volunteers three times daily. 

“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,” she said.

The article, with more recommendations, can be found here. Dr. Inouye is the director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife in Boston.