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. 2021 May;190(2):469-474.
doi: 10.1007/s11845-020-02372-7. Epub 2020 Sep 21.

Atypical presentation of COVID-19 in hospitalised older adults

Jasmine Ming Gan  1 , Jason Kho  1 , Michelle Akhunbay-Fudge  1 , Hwei Ming Choo  1 , Melanie Wright  1 , Farzana Batt  1 , Amit K J Mandal  2 , Rahul Chauhan  1 , Constantinos G Missouris  1   3
Affiliations

Atypical presentation of COVID-19 in hospitalised older adults

Jasmine Ming Gan et al. Ir J Med Sci. 2021 May.

Abstract

Background: It is increasingly recognised that older patients may not present with typical symptoms of COVID-19.

Aims: This study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19.

Methods: A retrospective analysis of adults ≥ 65 years with confirmed COVID-19 admitted to our institution between 1 March and 24 April 2020 was performed. Patients were categorised into typical or atypical groups based on primary presenting complaint in the community.

Results: One hundred twenty-two patients (mean age 81 ± 8 years; 62 male) were included. Seventy-three (60%) were categorised into the typical group and 49 (40%) into the atypical group. In the atypical group, common presenting complaints were fall in 18 (36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%). Further assessment by paramedics and on admission found 32 (65%) to have typical features of COVID-19, fever being the most common, and 22 (44%) were hypoxic. This subset had worse outcomes than those in the typical group with a mortality rate of 50% versus 38%, respectively, although this was not statistically significant (P = 0.27). No significant difference in mortality or length of hospital stay between the groups was demonstrated.

Conclusion: Older patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.

Keywords: Atypical symptoms; COVID-19; Coronavirus; Older adults.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

References

    1. Gov.uk (2020) Coronavirus (COVID-19) in the UK https://coronavirus.data.gov.uk. Accessed 11 June 2020
    1. Holroyd-Leduc J, Gandell D, Miller A, Petrov D (2020) COVID-19 in older adults https://www.rgptoronto.ca/wp-content/uploads/2020/04/COVID-19-Presentati.... Accessed 11 June 2020
    1. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi: 10.1056/NEJMoa2002032. - DOI - PMC - PubMed
    1. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14–e18. doi: 10.1016/j.jinf.2020.03.005. - DOI - PMC - PubMed
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed