@article {Huntclinmed.2021-0308, author = {Clare Hunt and Flora Olcott and George Williams and Terrence Chan}, title = {Failing the frail: The need to broaden the COVID-19 case definition for geriatric patients}, elocation-id = {clinmed.2021-0308}, year = {2021}, doi = {10.7861/clinmed.2021-0308}, publisher = {Royal College of Physicians}, abstract = {The 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{\textdegree}C on admission while 20.4\% were hypothermic with a temperature \<36.4{\textdegree}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.}, issn = {1470-2118}, URL = {https://www.rcpjournals.org/content/early/2021/10/11/clinmed.2021-0308}, eprint = {https://www.rcpjournals.org/content/early/2021/10/11/clinmed.2021-0308.full.pdf}, journal = {Clinical Medicine} }