aymptomatic older patients, delirium
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Asymptomatic older patients of COVID-19 are one of the most difficult to identify – now, researchers find that delirium could be an indicator of the virus

Asymptomatic patients of COVID-19 have been a source of discussion throughout this pandemic. How many of them are there, can they transmit the virus like active COVID-19 patients or not?

According to Krutika Kuppalli, an infectious-disease researcher at Stanford University School of Medicine in California: “Asymptomatic is someone who never developed symptoms ever throughout the course of their disease, and pre-symptomatic is somebody who has mild symptoms before they do go on to develop symptoms.”

In addition to that, an analysis of available data found that asymptomatic people were 42% less likely to transmit the virus – meaning that they still need to take the same precautions as people who are actively infected. Yet the question remains: How can healthcare professionals know who is asymptomatic when the symptoms are non-existent?

The new way to identify older patients showing no other symptoms

The fact that adults aged 65 and older are at the greatest risk of severe COVID is becoming increasingly certain, as data continues to pile-up and vaccination priorities are established ahead of the much-anticipated launch of many vaccines in Spring, 2021. However, those aged over 65 are only 16% of the US population and yet account for 80% of deaths so far.

Sharon K. Inouye, MD, MPH, Director of the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, are senior authors on the study.

Researchers looked at 817 patients of that age group, who were submitted to the emergency room and then diagnosed with COVID-19. Almost a third had delirium at the time they were seen. Interestingly, 37% of this sample group had no COVID-19 symptoms, and 16% had a delirium diagnosis.

What is delirium?

Delirium is an acute state of confusion, characterised by an altered level of consciousness, disorientation, inattention, and other cognitive disturbances.

Beyond COVID-19, delirium is known to be a common symptom in older adults with severe disease in the Emergency Room and is associated with extended hospitalisation, and increased morbidity and mortality. Despite the threat delirium poses to older patients, it is undetected in two-thirds of cases.

Dr Inouye commented: “This study demonstrates that delirium is not only a common symptom of COVID-19, but also may be the leading and possibly sole symptom in older persons.

“Thus, delirium should be considered an important presenting symptom of COVID-19.”


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