PT  - JOURNAL ARTICLE
AU  - Clare Hunt
AU  - Flora Olcott
AU  - George Williams
AU  - Terrence Chan
TI  - Failing the frail: The need to broaden the COVID-19 case definition for geriatric patients
AID  - 10.7861/clinmed.2021-0308
DP  - 2021 Oct 12
TA  - Clinical Medicine
PG  - clinmed.2021-0308
4099  - http://www.rcpjournals.org/content/early/2021/10/11/clinmed.2021-0308.short
4100  - http://www.rcpjournals.org/content/early/2021/10/11/clinmed.2021-0308.full
AB  - 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°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.