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Atypical COVID Symptoms Common in Older Adults

NEW YORK (Reuters Health) – New research provides more evidence that older adults with COVID-19 often present with atypical symptoms, including functional decline and altered mental status, and pinpoints demographic and clinical factors associated with atypical presentation.

Those most at risk are adults age 75 and older, women, Blacks and non-Hispanics, those with a higher comorbidity index and those who have dementia and/or diabetes, according to the Journal of Gerontology report.

“As the pandemic wanes, awareness of an atypical presentation may translate to earlier COVID diagnosis, which is critically important to preventing transmission of the disease among older adults, as well as broader hospital populations, health care workers, and family members,” lead researcher Dr. Allison Marziliano, assistant professor at the Feinstein Institutes for Medical Research in Manhasset, New York, told Reuters Health by email.

“While increasing clinicians’ awareness is important, so too is increasing lay awareness, so that older adults and their caregivers do not delay seeking treatment,” Dr. Marziliano said.

The researchers analyzed electronic health record data for 4,961 patients aged 65 and older with COVID-19 who were admitted across Northwell Health hospitals, the largest health system in New York State, in March and April 2020, with patient follow-up lasting until June 2020.

While many patients had with typical COVID-19 symptoms, including shortness of breath (50%), fever and chills (38%) and cough (27%), many also presented with atypical symptoms characterized by functional decline (25%) and altered mental status (11%). Other atypical symptoms included gastrointestinal (9%), cardiovascular (4%) and neurological (3%).

Among adults with atypical COVID-19 presentation, 49% had atypical signs and symptoms alone and 51% had both atypical and typical symptoms and signs.

The researchers examined four outcomes (hospital length of stay, hospital mortality, hospital readmission within 30 days and intensive care unit-level care) between older adults who had typical versus atypical presentation.

“We found that those who presented typically were 1.39 times more likely than those who presented atypically to receive ICU-level care. Hospital outcomes of mortality, length of stay and 30-day readmission, however, were similar between older adults with typical versus atypical presentations,” Dr. Marziliano told Reuters Health.

“The findings regarding outcome are clinically meaningful, as they highlight the importance of an atypical presentation,” she said.

“While we found that atypical presentation in older adults does not necessitate the same need for ICU-level care as typical presentation (often characterized by respiratory distress), it must not be dismissed, as those presenting atypically have just as poor short-term outcomes of hospital length of stay, 30-day readmission and hospital mortality as those older adults presenting typically,” Dr. Marziliano added.

In a statement, Dr. Kevin Tracey, president and CEO of the Feinstein Institutes, congratulated Dr. Marziliano and her team for providing “valuable insight into a patient population that is often understudied, particularly in regards to COVID-19. This study and future research will improve the care for older adults with COVID-19 and better inform the frontline workers tasked with assessing these patients’ needs.”

This research had no commercial funding and the authors have declared no conflicts of interest.

SOURCE: Journal of Gerontology, online July 19, 2021.

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