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The Forgotten Crisis Within a Crisis: The Hidden Delirium Epidemic Amid COVID-19 in Elderly Patients

The drastic impact of the COVID-19 pandemic on the world cannot be overstated, but it is most acutely felt among the elderly population. Representing only 20 percent of the Canadian populace, individuals aged 60 years and older unfortunately account for a disproportionate 69.5 percent of all hospitalizations and 91.7 percent of deaths due to COVID-19.

In the flurry of pandemic response, the rampant occurrence of delirium in hospitalized older adults – a distressing and unsettling state of mental confusion often spurred by health changes such as infection or surgery – has seen less attention. Nearly half of this demographic experience delirium, a condition that can wreak long-term cognitive havoc and increase the risk of dementia. Yet, delirium can be subdued or entirely averted through essential, straightforward strategies. These include prioritizing the presence of a family caregiver, advocating for patient mobility, and mitigating disruptions to fundamental functions such as eating, drinking and sleeping.

In an insightful OpEd penned by geriatrician Dr. Sharon Inouye in May 2020, she presciently cautioned against the emergence of an ‘epidemic within the pandemic’. She cited the neglect of these basic care strategies, leading to amplified vulnerability to delirium among elderly hospitalized patients. Recent research affirms the grim reality of her conjecture, with our study in JAMA Network Open revealing amplification of delirium occurrence among older adults hospitalized in Ontario during the initial two years of the pandemic. This group also exhibited a higher prescription rate of sedating medications post-discharge compared to the pre-pandemic era.

This alarming shift can be attributed to pandemic-induced disruptions in delirium preventive care. Limited staffing and volunteers, visitor restrictions, and stringent infection control rules led to diminished patient interaction and a decline in the application of non-pharmacological interventions for delirium prevention and management. The current state of affairs mars the steady progress achieved in delirium care over the last three decades, evidenced by thriving initiatives like Senior-Friendly hospitals, acute care of the elderly units, and hospital elder life programs across Canada. However, rising delirium cases and consequent increased sedative prescriptions highlight COVID-induced setbacks.

As we brace for a potential surge of viral illnesses during the imminent fall and winter, this trend requires immediate reversal. Thus, immediate efforts should be directed towards implementing policies for dignified, patient-centered care focused on our cognitively impaired elderly, reinstating nationwide stringent hospital policies that highlight flexible visitations, and adopt evidence-based preventive strategies against delirium.

Concurrently, it remains crucial to address the staffing crunch that has struck health care facilities nationwide, with a dedicated emphasis on fostering elderly-friendly health care environments. As a society, we owe it to our aging citizens to ensure they receive optimal care, reducing delirium and the overuse of sedatives, thus preserving their independence and intact cognition.


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