Ir J Med Sci . Atypical presentation of COVID-19 in hospitalised older adults

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Ir J Med Sci


. 2020 Sep 21.
doi: 10.1007/s11845-020-02372-7. Online ahead of print.
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

• PMID: 32959219
• DOI: 10.1007/s11845-020-02372-7

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.