Munawar Nida, Syed Rubab, Costello Maria, Robinson David, Bergin Colm, Greene Elaine
St. James Hospital, James Street, 8, Dublin, D08 NHY1, Ireland.
Trinity College Dublin, College Green, 2, Dublin, D02 PN40, Ireland.
Aging Health Res. 2023 Mar;3(1):100125. doi: 10.1016/j.ahr.2023.100125. Epub 2023 Feb 3.
Older adults with COVID-19 are more likely to present with atypical symptoms, notably delirium. The main objective of this meta-analysis is to identify risk factors for delirium and outcomes of delirium in hospitalized older adults (65 years or above) with COVID-19.
Comprehensive literature search of Embase, CINAHIL, Medline and Web of Science was performed for published literature until 31st August 2021. Two independent researchers evaluated study eligibility and assessed study quality using the Newcastle Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) critical appraisal tools for case series. The association of various predisposing factors with delirium in this cohort was reported as odds ratio (OR) and its 95% confidence interval (CI).
A total of 31 studies from 11 countries were included in this review. Most of the included studies investigated patients from non-ICU settings ( = 24; 77.4%). Frailty (OR 3.52, 95% CI: 1.96-6.31, <0.0001, I=71.63%), cognitive impairment including dementia (OR 6.17, 95% CI: 2.92-13.07, <0.00001, I=88.63%) and being nursing home residents (OR 1.72, 95% CI: 1.31-2.24, <0.0001, I=0) were significantly associated with increased likelihood of developing delirium in older adults with COVID-19. The presence of delirium also significantly increases mortality risk in hospitalized older adults with COVID-19 (OR 2.51, 95% CI: 1.51-4.17, <0.0001, I=89.3%).
Our review identifies key factors associated with increased risk of developing delirium in hospitalized older adults with COVID-19. Identification of patients at risk of delirium and attention to these factors early during admission may improve outcomes for this vulnerable cohort.
感染新型冠状病毒肺炎（COVID-19）的老年人更有可能出现非典型症状，尤其是谵妄。本荟萃分析的主要目的是确定住院的65岁及以上感染COVID-19的老年人发生谵妄的危险因素及谵妄的后果。
对Embase、CINAHL、Medline和Web of Science进行全面文献检索，以查找截至2021年8月31日发表的文献。两名独立研究人员评估研究的合格性，并使用纽卡斯尔渥太华量表（NOS）评估队列研究的质量，使用乔安娜·布里格斯研究所（JBI）的批判性评价工具评估病例系列的质量。该队列中各种易感因素与谵妄的关联以比值比（OR）及其95%置信区间（CI）报告。
本综述共纳入了来自11个国家的31项研究。大多数纳入研究调查的是非重症监护病房（ICU）的患者（n = 24；77.4%）。虚弱（OR 3.52，95%CI：1.96 - 6.31，P < 0.0001，I² = 71.63%）、包括痴呆在内的认知障碍（OR 6.17，95%CI：2.92 - 13.07，P < 0.00001，I² = 88.63%）以及养老院居民（OR 1.72，95%CI：1.31 - 2.24，P < 0.0001，I² = 0）与感染COVID-19的老年人发生谵妄的可能性增加显著相关。谵妄的存在也显著增加了住院的感染COVID-19的老年人的死亡风险（OR 2.51，95%CI：1.51 - 4.17，P < 0.0001，I² = 89.3%）。
我们的综述确定了与住院的感染COVID-19的老年人发生谵妄风险增加相关的关键因素。识别有谵妄风险的患者并在入院早期关注这些因素可能会改善这一脆弱群体的预后。
