Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study.

Background: Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care.

Methods: A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression.

Results: Care home residents were less likely to experience cough (46.9% vs 72.9%,  = .002) but more likely to present with delirium (51.6% vs 31.4%,  = .018), particularly hypoactive delirium (40.6% vs 24.3%,  = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58,  = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09,  = .028). There were no differences in mortality or length of stay based on residential status.

Conclusion: COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.