ICJIM
Intercontinental Journal of Internal Medicine

The Intercontinental Journal of Internal Medicine aims to publish issues related to all fields of internal medicine of the highest scientific and clinical value at an international level and accepts articles on these topics. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Original Article
A comparative analysis of predisposing factors for delirium in hospitalized patients during and after COVID-19 restriction periods
Abstract
Aims: The COVID-19 pandemic has had a significant impact on hospitalized patients, with delirium emerging as a common and severe complication, especially during periods of strict restrictions. The influence of environmental and psychosocial factors on delirium during different phases of the pandemic remains underexplored. This study aimed to assess the differences in predisposing factors for delirium between the restriction and relaxed periods of the COVID-19 pandemic.
Methods: In this retrospective study, 102 patients diagnosed with delirium between January 2020 and December 2023 were included. Patients were divided into two groups based on their admission periods relative to the COVID-19 pandemic restrictions. Group 1 (n = 64) consisted of patients admitted during the period of strict COVID-19 measures (11 March 2020 – 30 June 2021), while Group 2 (n = 38) included those admitted after the restrictions were lifted (1 July 2021 – 30 June 2023). Demographic and clinical data were collected using the hospital's electronic information system and patient files.
Results: The mean age of the patients was 72.4 ± 11.5 years (range: 50 to 92 years), and 51% of them were male. There were no significant differences in the distribution of age, gender, and comorbidities across the two groups. Group 1 had a significantly higher ratio of patients with COVID-19 infection compared to Group 2 (60.9% vs. 36.8%, p = 0.024). Sleep deprivation was more common in Group 1 than in Group 2 (87.5% vs. 68.4%, p = 0.037). The duration of delirium was significantly longer in Group than in Group 2 (3 vs. 2 days p = 0.045). Patients in Group 1 had a significantly longer hospital stay compared to those in Group 2 (9 vs. 6 days p < 0.001). Although the mortality rate was observed to be higher in Group 1 compared to Group 2, this difference was not statistically significant (18.8% vs. 10.5%, p = 0.400).
Conclusion: During the restriction period of the COVID-19 pandemic, patients with delirium exhibited higher rates of COVID-19 infection, increased sleep deprivation, and longer delirium episodes compared to those during the relaxed period. The prolonged delirium duration and extended hospital stays observed in the restriction period suggest that environmental and psychosocial factors may have contributed to more severe outcomes.

Keywords : COVID-19, delirium, hospitalized patients, infection, pandemic restrictions, predisposing factors, sleep deprivation

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1. Butt I, Ochoa-Ferraro A, Dawson C, et al. Acute confusion as an Initial Presentation of SARS-CoV-2 Infection. <em>J Clin Neurol</em>. 2021;17(3):363-367. doi:10.3988/jcn.2021.17.3.363
2. Gogia B, Pujara D, Thottempudi N, et al. Impact of acute confusional state in patients with COVID-19 and a predictive score. <em>Cureus</em>. 2021;13(9):e18360. doi:10.7759/cureus.18360
3. Hosey MM, Needham DM. Survivorship after COVID-19 ICU stay. <em>Nat Rev Dis Primers</em>. 2020;6(1):60. doi:10.1038/s41572-020-0201-1
4. Ryan SL, Kimchi EY. Evaluation and management of delirium. <em>Semin Neurol</em>. 2021;41(5):572-587. doi:10.1055/s-0041-1733791
5. Marcantonio ER. Postoperative delirium: a 76-year-old woman with delirium following surgery. <em>JAMA</em>. 2012;308(1):73-81. doi:10.1001/jama.2012.6857
6. Marcantonio ER. In the clinic. Delirium. <em>Ann Intern Med</em>. 2011;154(11):ITC6-ITC16. doi:10.7326/0003-4819-154-11-201106070-01006
7. Zambrelli E, Canevini M, Gambini O, D&rsquo;Agostino A. Delirium and sleep disturbances in COVID-19: a possible role for melatonin in hospitalized patients?. <em>Sleep Med</em>. 2020;70:111. doi:10.1016/j.sleep.2020.04.006
8. Wilke V, Sulyok M, Stefanou MI, et al. Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome. <em>PLoS One</em>. 2022;17(12):e0278214. doi:10.1371/journal.pone.0278214
9. Martinotti G, Bonanni L, Barlati S, et al. Delirium in COVID-19 patients: a multicentric observational study in Italy. <em>Neurol Sci</em>. 2021;42(10):3981-3988. doi:10.1007/s10072-021-05461-2
10. Jesus TS, Bhattacharjya S, Papadimitriou C, et al. Lockdown-related disparities experienced by people with disabilities during the first wave of the COVID-19 pandemic: scoping review with thematic analysis. <em>Int J Environ Res Public Health</em>. 2021;18(12):6178. doi:10.3390/ijerph18126178
11. Li Z, Zhang Z, Zhang Z, Wang Z, Li H. Cognitive impairment after long COVID-19: current evidence and perspectives. <em>Front Neurol</em>. 2023;14:1239182. doi:10.3389/fneur.2023.1239182
12. Angevaare MJ, Joling KJ, Smalbrugge M, Hertogh C, Twisk JWR, van Hout HPJ. The effects of the 2020 COVID-19 lockdown on mood, behavior, and social and cognitive functioning in older long-term care residents. <em>J Am Med Dir Assoc</em>. 2022;23(9):1608 e9-1608 e18. doi:10.1016/j.jamda.2022.07.003
13. McArthur C, Saari M, Heckman GA, et al. Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents&rsquo; mental health: a data-driven approach in new brunswick. <em>J Am Med Dir Assoc</em>. 2021;22(1):187-192. doi:10.1016/j.jamda.2020.10.028
14. Levere M, Rowan P, Wysocki A. The adverse effects of the COVID-19 pandemic on nursing home resident well-being. <em>J Am Med Dir Assoc</em>. 2021;22(5):948-954. doi:10.1016/j.jamda.2021.03.010
15. European Delirium A, American Delirium S. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. <em>BMC Med</em>. 2014;12:141. doi:10.1186/s12916-014-0141-2
16. Barlas G, Ozturk H, Pehlivanturk G, Aydin S. Turkey&rsquo;s response to COVID-19 pandemic: strategy and key actions. <em>Turk J Med Sci</em>. 2021;51(SI-1):3150-3156. doi:10.3906/sag-2106-212
17. Ilhan MN, Tuzun H, Kilic R, Yildirim N. Nonpharmaceutical interventions in Turkey and worldwide during COVID-19 pandemic. <em>Turk J Med Sci</em>. 2021;51(SI-1):3207-3214. doi:10.3906/sag-2106-210
18. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. <em>Lancet</em>. 2014;383(9920):911-922. doi:10.1016/S0140-6736(13)60688-1
19. Rudolph JL, Inouye SK, Jones RN, et al. Delirium: an independent predictor of functional decline after cardiac surgery. <em>J Am Geriatr Soc</em>. 2010;58(4):643-649. doi:10.1111/j.1532-5415.2010.02762.x
20. Inouye SK, Marcantonio ER, Kosar CM, et al. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients. <em>Alzheimers Dement</em>. 2016;12(7):766-775. doi:10.1016/j.jalz.2016.03.005
21. Walle-Hansen MM, Ranhoff AH, Mellingsaeter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. <em>BMC Geriatr</em>. 2021;21(1):199. doi:10.1186/s12877-021-02140-x
22. McAvay GJ, Van Ness PH, Bogardus ST, Jr., et al. Older adults discharged from the hospital with delirium: 1-year outcomes. <em>J Am Geriatr Soc</em>. 2006;54(8):1245-1250. doi:10.1111/j.1532-5415.2006.00815.x
23. Marcantonio ER. Delirium in Hospitalized Older Adults. <em>N Engl J Med</em>. 2017;377(15):1456-1466. doi:10.1056/NEJMcp1605501
24. Rebora P, Rozzini R, Bianchetti A, et al. Delirium in patients with SARS-CoV-2 infection: a multicenter study. <em>J Am Geriatr Soc</em>. 2021;69(2):293-299. doi:10.1111/jgs.16969
25. Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. <em>Crit Care</em>. 2020;24(1):176. doi:10.1186/s13054-020-02882-x
26. Wong EK, Watt J, Zou H, et al. Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study. <em>CMAJ Open</em>. 2022;10(3):E692-E701. doi:10.9778/cmajo.20210176
27. Inouye SK. The Importance of Delirium and Delirium Prevention in Older Adults During Lockdowns. <em>JAMA</em>. 2021;325(17):1779-1780. doi:10.1001/jama.2021.2211
28. Rohr S, Muller F, Jung F, Apfelbacher C, Seidler A, Riedel-Heller SG. Psychosocial impact of quarantine measures during serious coronavirus outbreaks: a rapid review. <em>Psychiatr Prax</em>. 2020;47(4):179-189. doi:10.1055/a-1159-5562
29. Sun N, Wei L, Wang H, et al. Qualitative study of the psychological experience of COVID-19 patients during hospitalization. <em>J Affect Disord</em>. 2021;278:15-22. doi:10.1016/j.jad.2020.08.040
30. Kandori K, Okada Y, Ishii W, Narumiya H, Maebayashi Y, Iizuka R. Association between visitation restriction during the COVID-19 pandemic and delirium incidence among emergency admission patients: a single-center retrospective observational cohort study in Japan. <em>J Intensive Care</em>. 2020;8:90. doi:10.1186/s40560-020-00511-x
31. Rosenbloom-Brunton DA, Henneman EA, Inouye SK. Feasibility of family participation in a delirium prevention program for hospitalized older adults. <em>J Gerontol Nurs</em>. 2010;36(9):22-33. doi:10.3928/00989134-20100330-02
32. Farasat S, Dorsch JJ, Pearce AK, et al. Sleep and delirium in older adults. <em>Curr Sleep Med Rep</em>. 2020;6(3):136-148. doi:10.1007/s40675-020-00174-y
33. Watson PL, Ceriana P, Fanfulla F. Delirium: is sleep important? <em>Best Pract Res Clin Anaesthesiol</em>. 2012;26(3):355-366. doi:10.1016/j.bpa.2012.08.005
34. van der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JD. Is delirium after cardiac surgery related to plasma amino acids and physical condition? <em>J Neuropsychiatry Clin Neurosci</em>. 2000;12(1):57-63. doi:10.1176/jnp.12.1.57
35. Gabor JY, Cooper AB, Hanly PJ. Sleep disruption in the intensive care unit. <em>Curr Opin Crit Care</em>. 2001;7(1):21-7. doi:10.1097/00075198-200102000-00004
36. Eteraf-Oskouei T, Najafi M. The relationship between the serotonergic system and COVID-19 disease: A review. <em>Heliyon</em>. 2022;8(5):e09544. doi:10.1016/j.heliyon.2022.e09544
37. Alizadeh Arimi F, Zarghami M, Moosazadeh M, et al. Frequency of delirium and its associated factors among COVID-19 inpatients in Iran. <em>Clin Respir J</em>. 2023;17(5):414-428. doi:10.1111/crj.13609
38. Partinen M, Holzinger B, Morin CM, et al. Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire. <em>BMJ Open</em>. 2021;11(12):e050672. doi:10.1136/bmjopen-2021-050672
39. Alimoradi Z, Brostrom A, Tsang HWH, et al. Sleep problems during COVID-19 pandemic and its&rsquo; association to psychological distress: a systematic review and meta-analysis. <em>EClinicalMedicine</em>. 2021;36:100916. doi:10.1016/j.eclinm.2021.100916
40. Mandelkorn U, Genzer S, Choshen-Hillel S, et al. Escalation of sleep disturbances amid the COVID-19 pandemic: a cross-sectional international study. <em>J Clin Sleep Med</em>. 2021;17(1):45-53. doi:10.5664/jcsm.8800
41. Conte F, Cellini N, De Rosa O, et al. Dissociated profiles of sleep timing and sleep quality changes across the first and second wave of the COVID-19 pandemic. <em>J Psychiatr Res</em>. 2021;143:222-229. doi:10.1016/j.jpsychires.2021.09.025
42. Salfi F, Amicucci G, Corigliano D, et al. Two years after lockdown: Longitudinal trajectories of sleep disturbances and mental health over the COVID-19 pandemic, and the effects of age, gender and chronotype. <em>J Sleep Res</em>. 2023;32(3):e13767. doi:10.1111/jsr.13767
43. Al Huraizi AR, Al-Maqbali JS, Al Farsi RS, et al. Delirium and Its Association with short- and long-term health outcomes in medically admitted patients: a prospective study. <em>J Clin Med</em>. 2023;12(16)doi:10.3390/jcm12165346
44. van Gelder TG, van Diem-Zaal IJ, Dijkstra-Kersten SMA, de Mul N, Lalmohamed A, Slooter AJC. The risk of delirium after sedation with propofol or midazolam in intensive care unit patients. <em>Br J Clin Pharmacol</em>. 2024;90(6):1471-1479. doi:10.1111/bcp.16031
45. Markowitz JD, Narasimhan M. Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options. <em>Psychiatry (Edgmont)</em>. 2008;5(10):29-36.
46. Tomlinson EJ, Schnitker LM, Casey PA. Exploring antipsychotic use for delirium management in adults in hospital, sub-acute rehabilitation and aged care settings: a systematic literature review. <em>Drugs Aging</em>. 2024;41(6):455-486. doi:10.1007/s40266-024-01122-z
Article available in :
Volume 2, Issue 4, 2024
Page : 89-93
https://doi.org/10.51271/ICJIM-0043
Article Information
Received : 02 Eki 2024
Accepted : 24 Eki 2024
Published : 30 Eki 2024
Corresponding Author :

Demet Aygün Üstel: Department of Neurology, İstanbul Atlas University, Medicine Hospital, İstanbul, Turkiye

[email protected]
Citation : Aygün Üstel D, Filiz Karalar F. A comparative analysis of predisposing factors for delirium in hospitalized patients during and after COVID-19 restriction periods. Intercont J Int Med. 2024;2(4):89-93.

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