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Despite the health care system limitations and the clinical challenges of the pandemic, delirium screening and management remains an evidence-based cornerstone of critical care. This article discusses practical recommendations for delirium screening in the COVID pandemic era, tips for training health care workers in delirium screening, validated tools for detecting delirium in critically ill older adults, and approaches to special populations of older adults eg, sensory impairment, dementia, acute neurologic injury.
Delirium is common in critically ill older adults, who are more vulnerable to adverse outcomes, as was on full display in the Coronavirus disease COVID pandemic. Regular assessment for delirium is recommended, and many validated tools exist for detecting delirium in critically ill older adults. This assessment was a challenge amid the COVID pandemic, when personnel and personal protective equipment were limited. Special considerations are necessary for patients with certain conditions eg, sensory impairment, chronic neurodegenerative conditions, acute neurologic injury , which both increase risk for delirium and may be mistaken for delirium.
In COVID, these patients proved especially vulnerable to delirium and may have greater long-term cognitive impairment as a result. Ongoing studies are pursuing this aspect of survivorship from the pandemic. Delirium an acute disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that fluctuates over time was already prevalent in the ICU before the pandemic of the novel severe acute respiratory syndrome Coronavirus 2 SARS-CoV-2 causing COVID Older adults were already more prone to experiencing delirium because of multiple predisposing risk factors: dementia odds ratio [OR], 2.
The pandemic has raised many challenges in managing critically ill older adults, a population preferentially killed by COVID Mortalities for hospitalized adults aged in their 60s, 70s, and 80s are Even for survivors who physically recover from critical illness, delirium can have long-standing neuropsychiatric effects.
