During the pandemic, delirium emerged as a well-recognized complication of COVID-19, with particular importance due to its high prevalence and mortality, significance as a presenting sign that is easily missed, and preventable nature. Delirium, also referred to as “acute brain failure,” is a common presenting symptom of any severe illness in older adults. Given this, it is not surprising that delirium is a common accompaniment of severe COVID-19 in older adults. Recent studies have described occurrence rates of 25% to 37% in hospitalized patients not in the intensive care unit (ICU) and greater than 65% in patients in ICU. Development of delirium in patients with COVID-19 has been associated with a poor prognosis with increased mortality, even after controlling for comorbidity and illness severity.

Delirium is of heightened importance during the COVID-19 pandemic, with the disease disproportionately affecting older adults. The ability to recognize and manage delirium will directly affect clinical outcomes in this population. All older patients with suspected COVID-19 infection should be screened for delirium, because atypical presentations are typical in all older adults and because delirium is the sixth most common presenting symptom in older adults with COVID-19. Delirium remains multifactorial, with important reversible contributors. Nonpharmacologic multicomponent strategies remain the mainstay of prevention and management and finding creative ways to build a “new normal” for care of older adults will be essential. Approaches involving family members—remotely or with careful in-person visits—will be critical to provide comfort, communication, and connection for older adults. Families should be involved as part of the caregiving team to enhance both short-term and long-term outcomes of delirium for this vulnerable population.

Stay the course, stay well, mask up, get vaccinated, and stay tuned!