Impact of Visitor Restrictions Due to the COVID-19 Pandemic on the Occurrence of In-Hospital Delirium

BACKGROUND: Delirium is a frequent disorder among hospitalized patients and is associated with high care needs. Its prevention relies on orienting measures, which may have been compromised during the COVID-19 pandemic. OBJECTIVES: The aim of this study was to assess the association between visitor restrictions due to the COVID-19 pandemic and the occurrence of delirium. METHODS: A cross-sectional study was conducted in 44,812 acute discharges from 2019 to 2023, stratified by period according to visitor policies (in chronological order: pre-COVID, full restrictions, variable restrictions, visitor increase, and de-escalation). Delirium occurrence was defined as the presence of a new delirium diagnosis during hospitalization, the use of physical restraints, and/or the administration of delirium-related medications. Logistic regression analysis was used to assess differences in delirium occurrence among periods, adjusted by relevant variables. RESULTS: Admission during the COVID-19 pandemic was associated with a higher occurrence of delirium, with a crude odds ratio (OR) for the full restrictions period of 1.7 (95% CI: 1.5-1.9). In all periods, patients positive for COVID-19 had a higher occurrence of delirium with crude ORs above 2. After adjustment for covariates, the highest ORs were observed during the variable restrictions period (OR: 1.34, 95% CI: 1.22-1.48) among COVID-19-negative patients, and when visitors increased (OR: 2.11, 95% CI: 1.82-2.46) among COVID-19-positive patients. CONCLUSIONS: The occurrence of delirium was high and was increased by all types of visitor restrictions during the COVID-19 pandemic. Appropriate visitor policies should be considered in preparation for similar future situations.