key: cord-0687109-d4z63s78
authors: Lozano-Montoya, Isabel; Quezada-Feijoo, Maribel; Jaramillo-Hidalgo, Javier; Gómez-Pavón, Francisco J.
title: Atypical symptoms of COVID-19 in hospitalised oldest old adults
date: 2020-12-10
journal: Rev Esp Geriatr Gerontol
DOI: 10.1016/j.regg.2020.11.001
sha: dc1d4baa562721b186c76bd0ff8955082343041e
doc_id: 687109
cord_uid: d4z63s78

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Atypical symptoms of COVID-19 in hospitalised oldest old adults

Infection misdiagnosis is common in older adults since infections may present differently than in the general population 1 COVID-19 is typically signalled by three symptoms: fever, cough and dyspnoea and is particularly fatal for older adults. 2, 3 Atypical symptoms recognition in these extremely vulnerable populations is critical for early detection, screening and intervention. However, atypical symptoms in older adults are not well established. We report clinical characteristics and presenting symptoms of COVID-19 in advanced age patients attended in a specialized geriatric hospital in Madrid, a city where the SARS-CoV-2 pandemic was particularly bad. The study protocol was approved by the Ethics Committee, under the ID: PI-4131.

Between March 20 and April 30, 2020, we attended 111 patients with probable or definitive COVID-19 diagnosis. 4 Table 1 shows demographic and clinical characteristics, including geriatric assessments. Mean age (85.5 ± 6.6 y) is higher than in studies, which defined COVID-19 clinical characteristics. 5 Many patients were frail with significant co-morbidities. However, a high proportion had no or only mild functional or cognitive impairment (Table 1) . 47 patients (42.3%) did not present fever and 27 (24.3%) neither fever nor cough. Amongst atypical symptoms stands out the delirium (hyperactive or hypoactive) assessed by Confusion Assessment Method (CAM), 6 present in more than 40% of patients, and high prevalence of falls as presenting symptom (14.4%). Fever absence was significantly more frequent in patients with falls compared to patients with other presenting symptoms (68.5%, vs. 37.9%; p = 0.021). Nearly 93% of patients had radiographically confirmed pneumonia.

Global in-hospital mortality was 45.9%. Patients with delirium had nearly double in-hospital death risk compared to those with other presenting symptoms (61.7% vs. 34.4%; p = 0.004). Interestingly, patients with delirium presented lower functional status (Barhtel Index: 58.5 ± 30 vs. 77.2 ± 27.7; p = 0.001), more frailty (proportion of at least moderate frailty: 54.3% vs. 29.6%; p = 0.009) and more cognitive impairment (proportion of at least moderate dementia: 28.3% vs. 12.5%; p = 0.038) than patients without delirium. Fever is the key method for COVID-19 screening. 7 However, in older adults awareness of other clinical features is mandatory, including falls and delirium, which may coincide with infection onset. 1, 8 Cardinal delirium manifestations are cognitive disturbances with impaired orientation, temporal fluctuation, and onset in few hours or days. 9, 10 In our series it is associated to poorer prior functional and cognitive status, and higher mortality.

Physicians and general population must gain knowledge of the COVID-19 special and unique aspects in geriatric populations 

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Gómez-Pavón a,b a Servicio de Geriatría, Hospital Central de la Cruz Roja