The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection

Abstract

COVID-19; Delirium; Geriatric rehabilitation

COVID 19; Deliri; Rehabilitació geriàtrica

COVID-19; Delirio; Rehabilitación geriátrica

Objectives Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. Design This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. Setting and Participants Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. Methods Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol–5 Dimensions–5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. Results Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = −0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = −0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. Conclusions and Implications Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.

This work was supported by Zorg Onderzoek Nederland en Medische Wetenschappen (ZonMw) to the COVID-19 Outcomes in Older People (COOP) study (project number 10430102110005) under the COVID-19 program. The COOP consortium is a national collaboration in the Netherlands between stakeholders from different care settings (hospitals, primary care practices, and nursing homes) and a Seniors Advisory Board (Ouderenraad). Additionally, it was supported by ZonMW to the University Network of the Care sector South-Holland (UNC-ZH) (grant number 640001003) and by the Leiden University Fund (Leiden Empowerment Fund, grant number LEF2106-2-47). The funders had no role in the study design; in the collection, analysis and interpretation of the data in the writing of the report; and in the decision to submit the article for publication.