A 5-year cross-sectional study published yesterday in JAMA Network Open shows the absolute rates of delirium among hospitalized older adults increased from 35.9 per 1,000 admitted population during the years immediately preceding the pandemic, to 41.5 per 1,000 admitted population throughout the first 2 years of the pandemic.
As many as 30% of hospitalized elderly adults experience delirium, defined by confusion, agitation, and problems with awareness. If untreated or unrecognized, delirium raises the risk of developing dementia and significant mental health issues.
In the present study, researchers mined databases to measure rates of delirium and related medication prescriptions (antipsychotics and minor tranquilizers) among adults ages 66 years or older hospitalized before and during the COVID-19 pandemic (January 1, 2017, to March 31, 2022) in Ontario, Canada. In total the study included 1,047,680 older adults with 2,128,411 hospital admissions.
For all hospitalizations, the median length of stay was 5 days, and 6.3% of patients were discharged to an inpatient rehabilitation facility.
The observed rates of delirium during the first 2 years of the pandemic were then compared to projected rates based on modeling from 3 years before pandemic onset.
"The onset, recognition, and management of delirium may have been affected by overwhelmed hospital capacity, staff shortages, isolation procedures, and reduced contact with friends and family due to visitor restrictions," the authors said.
The adjusted rate ratio (ARR) of delirium during the pandemic compared with the projected rate was 1.15 (95% confidence interval [CI], 1.11 to 1.19).
Concerns about discharge prescriptions
In another sign that delirium rose during the first 2 years of the pandemic, monthly rates of new antipsychotic prescriptions increased from 6.9 to 8.8 per 1,000 discharged population, and new benzodiazepine (minor tranquilizer) prescriptions increased from 4.4 to 6.0 per 1,000 discharged population.
Those rates were significantly higher during the pandemic compared with projected rates (antipsychotics: ARR, 1.28; 95% CI, 1.19 to 1.38; benzodiazepines: ARR, 1.37; 95% CI, 1.20 to 1.57).
The authors found prescription rates increased during three distinct pandemic waves: waves 1 (March to June 2020), 3 (March to June 2021), and 5 (December 2021 to February 2022).
The authors of the study said that many of the early pandemic precautions could have contributed to increased rates of delirium. "Mandated infection control procedures also led to prolonged periods during which older patients were in bed and isolated," they wrote. "And the use of masks and face shields could have disrupted communication during patient and staff interactions."
Limited capacity for in-person follow-up care may have also resulted in more prescriptions upon hospital discharge, the authors said. "Our finding that these medications were continued after discharge is concerning," they concluded. "Long-term use of these medications in older adults is associated with adverse events, such as falls and stroke."