Real-world data from Japan suggest that an organic mental disorder (one not caused by psychiatric illness, such as Alzheimer’s disease [AD] and/or delirium) is a key risk factor for COVID-19 infection and hospitalization among older adults.
Researchers at Juntendo University in Tokyo analyzed data on patients registered in the Japanese Health Insurance Database between January 2014 and December 2019 to identify hospitalized patients aged 60 years and older newly diagnosed as having COVID-19 by December 2020. Follow-up ended in October 2022.
The 8,072 patients were matched 1:1 with uninfected peers by age, sex, and illness onset. The researchers conducted a case-control study to identify risk factors for COVID-19 infection in the three months before diagnosis and a retrospective cohort study using time-to-event analysis to assess the risk of post-infection complications.
Pandemic-related social restrictions “caused significant lifestyle changes, raising concerns about their impact on physical and mental health through the deterioration of health-related behaviors, including reduced physical activity, sleep disturbances, and poor dietary habits,” the authors noted.
The findings were published in the International Journal of Infectious Diseases.
Higher risk of new-onset behavioral syndromes
The strongest predisposing factor for COVID-19 infection was an organic mental disorder, which carried 2.3 times the risk, followed by fungal disease and kidney failure, both posing 1.2 times the risk.
Our findings emphasize that mental and behavioral disorders are crucial health risk factors that should be addressed before and after infection.
Infected patients were at 3.5 times the risk for new-onset behavioral syndromes (eg, eating disorders, sleep disorders), followed by pulmonary heart disease and diseases of pulmonary circulation (3.0 times the risk) and sexually transmitted infections (2.8 times).
The authors noted that the underlying conditions that often co-occur in older adults (eg, cardiovascular disease) are risk factors for AD.
“Moreover, as these comorbidities are risk factors for severe COVID-19, the overlapping presence of these risks in patients with AD may further increase their susceptibility to COVID-19,” they wrote. “Some studies have noted that delirium is a predictor of severe COVID-19.”
“Our findings emphasize that mental and behavioral disorders are crucial health risk factors that should be addressed before and after infection,” they added.