Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: a retrospective observational study in Glasgow, Scotland

Abstract

Introduction: Understanding of how SARS-CoV-2 manifests itself in older adults was unknown at the outset of the pandemic. We undertook a retrospective observational analysis of all patients admitted to older people’s services with confirmed COVID-19 in one of the largest hospitals in Europe. We detail presenting symptoms, prognostic features and vulnerability to nosocomial spread. Methods: We retrospectively collected data for each patient with a positive SARSCoV-2 RT PCR between 18th March and the 20th April 2020 in a department of medicine for the elderly in Glasgow. Results: 222 patients were included in our analysis. Age ranged from 56 to 99 years (mean = 82) and 148 were female (67%). 119 patients had a positive swab for SARS-CoV-2 within the first 14 days of admission, only 32% of these patients presented with primarily a respiratory type illness. 103 patients (46%) tested positive after 14 days of admission – this was felt to represent likely nosocomial infection. 95 patients (43%) died by day 30 after diagnosis. Discussion: This data indicates that older people were more likely to present with non-respiratory symptoms. High clinical frailty scores, severe lymphopenia and cumulative comorbidities were associated with higher mortality rates. Several contributing factors will have led to nosocomial transmission.

Clinical frailty scale as a point of care prognostic indicator of mortality in COVID-19: a systematic review and meta-analysis

“…S1C). Interestingly, almost a quarter of patients, 24.1% (SD: 14.5) [1742/7226] [22,24,25,27,28,36,38,41,47] either presented or developed delirium during their hospital admission (Fig. S1C).…”

“…Full-text screening excluded 30 studies (Table S3, companion file). A total of 34 studies remained [ 4 , 5 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ], all of which were included in the systematic review while 17 were included in the meta-analysis [ 4 , 5 , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ] ( Fig. 1 ; Table S1).…”

“…Over half (57.2%) [10,320/18,042] [ 4 , 5 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ] of the COVID-19-positive patients were male (Fig. S1C), 30.6% [4691/15,430] [ 4 , 5 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , 27 , [29] , [30] , [31] , [32] , [33] , [35] , [36] , 38 , 40 , 42 , [45] , [46] , [47] ] of the patients suffered from cardiovascular co-morbidities, 12.19% [1556/12,761] [ 4 , [16] , [17] , [18] , [19] , 21 , [23] , …”

Severe Acute Respiratory Syndrome Coronavirus 2

“…Symptoms of COVID-19 are multi-system in nature; 370,000 confirmed COVID-19 cases in the United States reported symptoms including cough (50%), fever (subjective or > 38°C, in 43%), myalgia (36%), headache (34%), dyspnoea (29%), sore throat (20%), gastrointestinal symptoms such as diarrhea and nausea/vomiting (20%) and disorders of smell and taste in 10% ( Stokes et al, 2020 ). Older patients, especially those with dementia may present with relatively non-specific findings such as poor appetite, falls or hypoactive delirium, which underlines the difficulties associated with defining asymptomatic infection ( Davis et al, 2020 ). Symptomatic infection in children and adolescents is relatively uncommon; when it occurs, it is usually mild, although a small proportion (e.g., 1–2%) experience severe disease ( Stokes et al, 2020 ).…”

COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis

“…Furthermore, atypical presentation of COVID-19 infection such as delirium is commonly described among older people [ 6 , 7 ]. Older persons were less likely to present with respiratory symptoms [ 6 , 7 ]. This poses a diagnostic challenge that leads to potential treatment delay.…”