Coronavirus UK: ‘Delirium’ is a key coronavirus symptom in older people – how to spot it

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Coronavirus cases are estimated to be exceeding 35,200 a day in England, according to the latest data from the Office for National Statistics. While the focus has been on transmission amongst the young, older people are disproportionately at a higher risk. It is therefore imperative to watch out for the warning signs in this at-risk group and take measures to minimise the risks posed to them.

The main symptoms associated with coronavirus are a high temperature, a new, continuous cough and a loss or change to your sense of smell or taste, according to the NHS.

Research has also identified another main symptom amongst older people – delirium.

Recent results from the COVID Symptom Study show that delirium is a key symptom of COVID-19 in older people.

In light of the finding, Public Health England has updated its COVID-19 guidance for elderly people presenting with delirium.

What is delirium?

“Delirium is a state of acute confusion that starts suddenly and can occur during any illness,” explains Dr Claire Steves, consultant geriatrician and lead researcher on the delirium study.

According to Dr Steves, the exact trigger may not always be clear, but delirium can be associated with low oxygen levels or the effects of the underlying illness on the brain.

“It is generally more common in older people who need help with daily life – for example due mobility problems, poor eyesight, hearing problems or existing memory issues such as dementia,” she said.

Although COVID-19 is caused by a virus that affects the airways, Dr Claire and her fellow clinicians quickly realised that it was also having an effect on the brain.

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“Early in the pandemic, we noticed that many frail, older patients with COVID were suffering from delirium, but there was very little data to support our experiences,” she said.

“So when we devised the COVID Symptom Study app, we made sure that it asked questions about confusion, disorientation and drowsiness, which are the core symptoms of delirium, so that we could gather some information.”

To confirm the link, Dr Claire and her collaborators also assessed older patients with COVID-19 at St Thomas’ hospital in London for signs of delirium.

The finding proved consistent across both data sets, revealing that delirium was strongly associated with a positive COVID-19 test.

They also saw that a third of the people who tested positive for COVID and reported signs of delirium through the app did not have a fever or a cough, while one in five hospitalised patients with COVID-19 did not have any other classic symptoms of the disease.

In light of the findings, Dr Claire is calling for doctors and carers to look out for “acute” confusion in older people and ensure they get tested as soon as possible to suppress the transmission.

How can I reduce the risk of spreading coronavirus to people I live with?

If you are self-isolating because of coronavirus, there are things you can do to reduce the chances of spreading any infection to the people you live with.

If you have symptoms, you should stay away from other people you live with as much as possible.

According to the NHS, you can should try to:

  • Stay on your own in one room as much as possible and keep the door closed
  • Avoid using shared spaces (such as the kitchen) at the same time as other people – eat your meals in your room
  • Use a separate bathroom – otherwise, use the bathroom after everyone else and clean it each time you use it, for example, by wiping the surfaces you’ve touched.

You should also:

  • Wash your hands with soap and water often, for at least 20 seconds
  • use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards
  • Clean objects and surfaces you touch often (such as door handles, kettles and phones) using your regular cleaning products
  • Consider wearing a face covering when in shared spaces
  • Keep windows open in the room you’re staying in and shared spaces as much as possible.

The NHS also advises against sharing towels, including hand towels and tea towels.

“If you live with someone at higher risk, try to arrange for them to stay with friends or family while you’re self-isolating,” it adds.

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