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Add COVID-19 to the many conditions that can present with delirium among older adults treated in the emergency department (ED) setting. This JAMA multicenter cohort study followed more than 800 adults aged 65 and older who presented in the ED with COVID-19 at seven U.S. sites starting in March 2020. Delirium was the sixth most common of all presenting COVID-19 signs and symptoms. Among the delirious patients, 16 percent presented with delirium as a primary symptom. Surprisingly, 37 percent of these patients had no other typical signs or symptoms of COVID-19, such as cough or fever. More