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Atypical presentation of COVID-19 in hospitalised older adults.

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.

SUBMITTER: Gan JM

PROVIDER: S-EPMC7505490 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Atypical presentation of COVID-19 in hospitalised older adults.

Gan Jasmine Ming JM Kho Jason J Akhunbay-Fudge Michelle M Choo Hwei Ming HM Wright Melanie M Batt Farzana F Mandal Amit K J AKJ Chauhan Rahul R Missouris Constantinos G CG

Irish journal of medical science 20200921 2

<h4>Background</h4>It is increasingly recognised that older patients may not present with typical symptoms of COVID-19.<h4>Aims</h4>This study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19.<h4>Methods</h4>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 pr ...[more]

PMID: 32959219

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Project description:BackgroundOlder adults from racial and ethnic minority groups are at higher risk for worse outcomes with COVID-19. This study sought to characterize the symptomatology of COVID-19 and the association of symptoms with all-cause in-hospital mortality and respiratory failure in a cohort of older, predominantly African American adults admitted to a tertiary hospital.MethodsA retrospective chart review of all hospitalized patients 65 and older with a positive SARS-CoV-2 test was conducted in a 953-bed academic, urban hospital. Measurements included demographics, symptoms, laboratory findings, and outcomes. The primary outcome was in-hospital mortality, and the secondary outcome was respiratory failure.ResultsA total of 134 patients with a mean age of 76.4 years were studied. Fifty-six percent were men and 90% were African American. Of these, 108 patients presented with typical symptoms, among whom 89.8% had co-existing geriatric syndromes. Only 10.2% presented with typical symptoms alone. The most common typical symptoms were fever (57%), shortness of breath (SOB) (51.2%), and cough (48.8%). Atypical symptoms were present in 68 (51%) patients, of whom 83.8% had co-existing typical symptoms and 76.5% had co-existing geriatric syndromes. Only 17.2% of patients presented with atypical symptoms alone. Atypical symptoms identified were anorexia (43%), dizziness (12.4%), and syncope (7.4%). Geriatric syndromes were identified in 102 (76%) patients, including altered mental status (71.1%), weakness (26.4%), and falls (24.8%). Respiratory failure occurred in 65.8% of patients, with 35.4% requiring ventilators while 22.3% of patients died. Age, male gender, SOB, sepsis, and certain laboratory values were associated with outcomes.ConclusionHospitalized older adults infected with SARS-CoV-2 may present with a range of symptoms encompassing typical, atypical, and geriatric syndromes. Early testing for COVID-19 should be considered in hospitalized older adults.

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Atypical presentation of COVID-19 in hospitalised older adults.

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Atypical presentation of COVID-19 in hospitalised older adults.

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