Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: a retrospective observational study in Glasgow, Scotland

Introduction:Understanding of how SARS-CoV-2 manifests itself in older adults was unknown at the outset of the pandemic. We undertook a retrospective observational analysis of all patients admitted to older people's services with confirmed COVID-19 in one of the largest hospitals in Europe. We detail presenting symptoms, prognostic features and vulnerability to nosocomial spread.Methods:We retrospectively collected data for each patient with a positive SARSCoV-2 RT PCR between 18th March and the 20th April 2020 in a department of medicine for the elderly in Glasgow.Results:222 patients were included in our analysis. Age ranged from 56 to 99 years (mean = 82) and 148 were female (67%). 119 patients had a positive swab for SARS-CoV-2 within the first 14 days of admission, only 32% of these patients presented with primarily a respiratory type illness. 103 patients (46%) tested positive after 14 days of admission - this was felt to represent likely nosocomial infection. 95 patients (43%) died by day 30 after diagnosis.Discussion:This data indicates that older people were more likely to present with non-respiratory symptoms. High clinical frailty scores, severe lymphopenia and cumulative comorbidities were associated with higher mortality rates. Several contributing factors will have led to nosocomial transmission.

Automated summary

This study conducted a retrospective analysis of patients with confirmed COVID-19 in a department of medicine for the elderly, revealing that older adults were more likely to present with non-respiratory symptoms. High clinical frailty scores, severe lymphopenia, and cumulative comorbidities were associated with higher mortality rates. Nosocomial transmission was also identified as a significant contributing factor to the spread of the virus.