Mark James Rawle1,2, Deborah Lee Bertfield1, Simon Edward Brill3. 1. Department of Geriatric Medicine Barnet Hospital Royal Free London NHS Foundation Trust London UK. 2. MRC Unit for Lifelong Health and Ageing at UCL London UK. 3. Department of Respiratory Medicine Barnet Hospital Royal Free London NHS Foundation Trust London UK.
Abstract
BACKGROUND: Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care. METHODS: A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. RESULTS: Care home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status. CONCLUSION: COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.
BACKGROUND: Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care. METHODS: A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. RESULTS: Care home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status. CONCLUSION: COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Giuseppe Bellelli; Paola Rebora; Maria Grazia Valsecchi; Paolo Bonfanti; Giuseppe Citerio Journal: Intensive Care Med Date: 2020-05-25 Impact factor: 17.440
Authors: Simon E Brill; Hannah C Jarvis; Ezgi Ozcan; Thomas L P Burns; Rabia A Warraich; Lisa J Amani; Amina Jaffer; Stephanie Paget; Anand Sivaramakrishnan; Dean D Creer Journal: BMC Med Date: 2020-06-25 Impact factor: 8.775
Authors: Jonathan Hewitt; Ben Carter; Arturo Vilches-Moraga; Terence J Quinn; Philip Braude; Alessia Verduri; Lyndsay Pearce; Michael Stechman; Roxanna Short; Angeline Price; Jemima T Collins; Eilidh Bruce; Alice Einarsson; Frances Rickard; Emma Mitchell; Mark Holloway; James Hesford; Fenella Barlow-Pay; Enrico Clini; Phyo K Myint; Susan J Moug; Kathryn McCarthy Journal: Lancet Public Health Date: 2020-06-30
Authors: A Bianchetti; R Rozzini; F Guerini; S Boffelli; P Ranieri; G Minelli; L Bianchetti; M Trabucchi Journal: J Nutr Health Aging Date: 2020 Impact factor: 4.075
Authors: Theodore D Cosco; John Best; Daniel Davis; Daniele Bryden; Suzanne Arkill; James van Oppen; Indira Riadi; Kevin R Wagner; Simon Conroy Journal: Age Ageing Date: 2021-01-14 Impact factor: 10.668
Authors: Marjolein E A Verbiest; Annerieke Stoop; Aukelien Scheffelaar; Meriam M Janssen; Leonieke C van Boekel; Katrien G Luijkx Journal: BMC Health Serv Res Date: 2022-07-15 Impact factor: 2.908
Authors: Theodore D Cosco; John Best; Daniel Davis; Daniele Bryden; Suzanne Arkill; James van Oppen; Indira Riadi; Kevin R Wagner; Simon Conroy Journal: Age Ageing Date: 2021-05-05 Impact factor: 10.668
Authors: Adam H Dyer; Aoife Fallon; Claire Noonan; Helena Dolphin; Cliona O'Farrelly; Nollaig M Bourke; Desmond O'Neill; Sean P Kennelly Journal: J Am Med Dir Assoc Date: 2022-07-04 Impact factor: 7.802
Authors: Flavia Dumitrascu; Karina E Branje; Emily S Hladkowicz; Manoj Lalu; Daniel I McIsaac Journal: J Am Geriatr Soc Date: 2021-06-05 Impact factor: 7.538