• Clare Hunt, Flora Olcott, George Williams, and Terrence Chan.
• Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK clare.hunt1@nhs.net.
• Clin Med (Lond). 2021 Nov 1; 21 (6): e604e607e604-e607.

AbstractThe older population has a high mortality with COVID-19 and this cohort often presents atypically with infection. This study compares presenting complaints and observations of older patients with COVID-19 against the established case definition to determine whether the case definition should be broadened to better identify SARS-CoV-2 infection in this age group.This retrospective observational study analysed the presenting complaints and observations of people aged 70 years and over who were admitted to a district general hospital with confirmed SARS-CoV-2 infection from March to May 2020.Out of 225 patients, only 11.5% presented with the trio of cough, fever and breathlessness; 30.2% did not present with any of these symptoms (p<0.001). The most frequent atypical complaints were delirium (25%), general malaise (20%) and falls (19%). Only 32.4% recorded a temperature ≥37.6°C on admission while 20.4% were hypothermic with a temperature <36.4°C (p=0.0003).A significant proportion of older patients with COVID-19 presented with non-specific symptoms and observations. The high proportion of falls and delirium emphasises the need for early geriatrician input, awareness of COVID-19 as a differential for confusion in older patients and to include falls in the case definition for COVID-19 in the older population.© Royal College of Physicians 2021. All rights reserved.

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