• Maria Beatrice Zazzara, Rose S Penfold, Amy L Roberts, Karla A Lee, Hannah Dooley, Carole H Sudre, Carly Welch, Ruth C E Bowyer, Alessia Visconti, Massimo Mangino, Maxim B Freidin, Julia S El-Sayed Moustafa, Kerrin S Small, Benjamin Murray, Marc Modat, Mark S Graham, Jonathan Wolf, Sebastien Ourselin, Finbarr C Martin, Claire J Steves, and Lochlainn Mary Ni MN Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London, SE1 7EH, UK..
• Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
• Age Ageing. 2021 Jan 8; 50 (1): 40-48.

BackgroundFrailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.ObjectiveTo assess how frailty affects presenting COVID-19 symptoms in older adults.DesignObservational cohort study of hospitalised older patients and self-report data for community-based older adults.SettingAdmissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.SubjectsHospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.MethodsMultivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.ResultsHospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.ConclusionsThis is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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