Examining the risk of delirium in patients hospitalized with COVID-19: Insights from the homeless population

• Published in: PloS one Vol. 20; no. 1; p. e0313242
• Main Authors: O’Neill, Liam, Chumbler, Neale R.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.01.2025; Public Library of Science (PLoS)
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Adolescent; Adult; Aged; Alanine - analogs & derivatives; Alcohol use; Alzheimer's disease; Antiviral agents; Antiviral drugs; Biology and Life Sciences; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - epidemiology; Brain research; Cannabis; Chronic illnesses; Codes; Cognitive ability; Comorbidity; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Delirium; Delirium - epidemiology; Delirium - etiology; Dementia; Disease; Disorders; Drug abuse; Drug addiction; Drug use; Ethnicity; Female; Head injuries; Health aspects; Health risks; Homeless people; Homeless persons; Homelessness; Hospital Mortality; Hospital patients; Hospitalization; Hospitals; Human subjects; Humans; Ill-Housed Persons - statistics & numerical data; Length of stay; Male; Marijuana; Medicine and Health Sciences; Mental disorders; Middle Aged; Mortality; Opioids; Pandemics; Patients; Psychological aspects; Regression analysis; Regression models; Retrospective Studies; Risk Factors; SARS-CoV-2 - isolation & purification; Software; Statistics; Substance abuse; Substance use; Substance use disorder; Substance-Related Disorders - complications; Substance-Related Disorders - epidemiology; Texas - epidemiology; Trauma; Traumatic brain injury; Treatment outcomes; Young Adult; Texas; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0313242

For patients hospitalized with COVID-19, delirium is a serious and under-recognized complication, and people experiencing homelessness (PEH) may be at greater risk. This retrospective cohort study compared delirium-associated risk factors and clinical outcomes between PEH and non-PEH. This study used patient records from 154 hospitals discharged from 2020–2021 from the Texas Inpatient Public Use Data file. Study subjects (n = 878) were patients, aged 18–69 years, who were hospitalized with COVID-19 and were identified as homeless. The baseline group included (n = 176,518) patients with COVID-19 aged 18–69 years who were not homeless. Logistic regression models were used to identify risk factors for delirium. Relevant risk factors included chronic comorbidities, substance use disorders, and traumatic brain injury (TBI). Seven of the delirium-associated risk factors were more prevalent among PEH compared to baseline. PEH had higher rates of TBI, alcohol, cannabis, and opioid use disorders. PEH had significantly higher rates of delirium (10.6% vs. 8.1%; P<0.01). However, PEH had fewer respiratory complications, including pneumonia (48.5% vs. 81.9%; P<0.001) and respiratory failure (28.7% vs. 61.9%; P<0.001), and lower in-hospital mortality (3.3% vs. 9.5%; P<0.001). The anti-viral Remdesivir had a protective effect against delirium (AOR = 0.63; CI: 0.60, 0.66). Mean hospital length of stay (LOS) was more than twice as long for delirious patients compared with non-delirious patients (18.4 days vs. 7.7 days; P<0.001). Delirium greatly increased the risk of in-hospital mortality (AOR = 3.8; CI: 3.6, 4.0). For PEH (n = 29) who died from COVID-19, delirium was present in more than half (52%) of cases. Hospitals should screen PEH for delirium and adopt nursing protocols to prevent delirium and reduce its severity.