TY - JOUR T1 - Failing the frail: The need to broaden the COVID-19 case definition for geriatric patients JF - Clinical Medicine JO - Clin Med SP - e604 LP - e607 DO - 10.7861/clinmed.2021-0308 VL - 21 IS - 6 AU - Clare Hunt AU - Flora Olcott AU - George Williams AU - Terrence Chan Y1 - 2021/11/01 UR - http://www.rcpjournals.org/content/21/6/e604.abstract N2 - 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. ER -