Clinical presentation and in-hospital outcomes of older patients hospitalized with COVID-19 in Montreal, Canada: a retrospective review

Abstract

BackgroundOlder adults are more vulnerable to severe infection and mortality due to COVID-19. They often have atypical presentations of the disease without respiratory symptoms, which makes early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older and younger patients hospitalized with COVID-19.MethodsThe charts of 429 consecutive patients hospitalized in Montreal, Canada, with PCR-confirmed COVID-19 were retrospectively reviewed. Baseline health, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older (≥70) versus younger (<70) individuals.ResultsOlder patients presented with more comorbidities compared to younger patients as captured by the Charlson Comorbidity Index (mean 6 vs 2), including higher rates of cardiovascular, cerebrovascular, chronic obstructive pulmonary, and chronic kidney disease. Older patients were less likely than younger patients to present with cough (27% vs 47%) or dyspnea (33% vs 48%). Fifty-two (52%) had no respiratory symptoms on presentation compared to 32% in the younger group (p<0.001); however, they were more likely to present with geriatric syndromes such as delirium (29% vs 7%), functional decline (14% vs 0.6%), or falls (15% vs 5%). Twelve (12%) of older patients presented with a geriatric syndrome as their sole symptom compared to 3% in the younger group (p=0.002). Older adults were more likely to develop acute kidney injury (35% vs 22%), malnutrition (9% vs 4%), delirium (29% vs 17%) and hypernatremia (32% vs 17%). They had higher in-hospital mortality (33% vs 13%, p<0.001).DiscussionOlder adults presenting to hospital with COVID-19 commonly have no respiratory symptoms and can present with only a geriatric syndrome. A new geriatric syndrome in an older person should trigger isolation and evaluation for COVID-19. Furthermore, older adults are particularly vulnerable to complications related to dehydration, warranting early initiation of multidisciplinary care.

Atypical Presentation of COVID-19 in Older Adults: A Scoping Review

“…A community study reported that about 40% (n = 122) have had atypical presentation of COVID-19 (fall-36%, reduced mobility-36%, and delirium-22%). In hospital admission, many older adults had no respiratory syndromes (52%) [14], but they were more likely to present geriatric syndromes, such as delirium [8,[14][15][16], functional decline [14], and falls [8,14]. A retrospective study in three medical departments in Denmark with patients ≥80 years old reported that atypical COVID-19 symptoms related to geriatric frailty syndromes were frequent, namely, confusion (29%), walking difficulty (13%), and falls (8%) [8].…”