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- Page navigation anchor for Delirium in Hospitalized Older Adults during the COVID19 PandemicDelirium in Hospitalized Older Adults during the COVID19 Pandemic
Delirium is an acute confusional state characterized by an alteration of consciousness with deficits in attention and is associated with poor outcomes1,2. Older age, dementia, and functional disabilities are predisposing factors, whereas acute illness, drugs, and acute exacerbation of chronic illness are common precipitating factors2. Multicomponent, nonpharmacologic interventions are regularly used to mitigate its risk factors, examples being various re-orientation protocols, cognitive stimulation, early mobilization, amongst others.
With the ongoing Covid19 Pandemic, recent epidemiological studies indicate that middle-aged and older adults are most commonly affected, with older adults being more likely to have severe disease3.
Essential knowledge regarding the treatment of COVID19 is being gained nearly daily. Though the management of the underlying disease remains paramount, older patients remain incredibly vulnerable to develop delirium and its complications. They may require longer hospitalizations, more prolonged ICU stays, while also being kept in isolation. These circumstances make the use of the above-mentioned interventions challenging. Physicians being unable to utilize non-pharmacological alternatives often have to rely on medications like antipsychotics and sedative agents.
Recognition of this potential dilemma is crucial for its prevention. The development of protocols and sharing of knowledge regarding measures used in different inpati...
Show MoreCompeting Interests: None declared.References
- Lauren Vogel. What’s next now that the WHO has declared a COVID-19 pandemic?. CMAJ 2020;192:E349-E350.
- 1.Joseph Francis Jr M, MPH. 2020. In: Michael J Aminoff M, DSc, Kenneth E Schmader M, eds. Delirium and acute confusional states: Prevention, treatment, and prognosis. UpToDate.
- 2.Marcantonio ER. Delirium in Hospitalized Older Adults. New England Journal of Medicine. 2017;377(15):1456-1466.
- 3.Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242.
- Page navigation anchor for Hookah smoking and COVID-19: Call for ActionHookah smoking and COVID-19: Call for Action
A hookah (shisha or waterpipe) is a single or multi- stemmed instrument used for smoking various flavored substances such as cannabis, tobacco and opium for centuries and is popular in the Indian subcontinent, the Arabian peninsula, Kenya, South Africa, Turkey, United States and Canada. Across the United States, 2.6 million people smoke hookah with a recent mushrooming of ‘hookah bars’ with 100 million hookah-ers globally.1,2 Comparably, in Canada its high prevalence particularly among young adults is a matter of growing concern.3
Smoking has emerged as an independent risk not only for transmission but also COVID-19 severity.4 Similarly hookahs are an ideal mode for transmission and may exacerbate the risk for severe COVID-19 through shared use. They have difficult-to-clean, long pipes and a cold water reservoir, ideal for coronavirus transmission. Further, hookah smoke contains several hazardous chemicals in addition to tobacco that injure the respiratory lining predisposing the smoker to viral infections, tuberculosis and other infectious diseases and the coronavirus is not exception. Though not formally reported, hookah smoking (like e-cigarettes) poses a threat of disproportionately increasing COVID-19 in the youth. Furthermore, MERS-CoV, another coronavirus infection, was also thought to be transmitted by waterpipe smoking.
Several countries have already placed restrictions on hookah use gi...
Show MoreCompeting Interests: None declared.References
- 1. Prevention CfDCa. Tobacco Product Use Among Adults — United States. November 9, 2018 2017.
- 2. Akl EA, Gunukula SK, Aleem S, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health. 2011;11(1):244.
- 3. Minaker LM, Shuh A, Burkhalter RJ, Manske SR. Hookah use prevalence, predictors, and perceptions among Canadian youth: findings from the 2012/2013 Youth Smoking Survey. Cancer Causes Control. 2015;26(6):831-838.
- 4. Liu W, Tao Z-W, Lei W, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J. 9000;Publish Ahead of Print.
- 5. Mediterranean WHOROftE. Tobacco and waterpipe use increases the risk of suffering from COVID-19. Tobacco Free initiative. 2020. http://www.emro.who.int/tfi/know-the-truth/tobacco-and-waterpipe-users-are-at-increased-risk-of-covid-19-infection.html. Acc