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

  1. Mark James Rawle
  2. Deborah Lee Bertfield
  3. Simon Edward Brill

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Abstract

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%, P  = .002) but more likely to present with delirium (51.6% vs 31.4%, P  = .018), particularly hypoactive delirium (40.6% vs 24.3%, P  = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P  = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P  = .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.

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  1. Version published to 10.1002/agm2.12126
  2. ScreenIT

    SciScore for 10.1101/2020.07.07.20148148: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 2.4 Ethical approval: The data presented here were collected during routine clinical practice and formal Research Ethics Committee review was not required.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    These data were also not without limitations. The comparisons drawn between institutional care and community care in our data do not account for differences between nursing home and residential home care, which cannot always be determined from address and admission history. Key differences may still exist between these subgroups. Likewise, community dwelling older adults have differing care needs, and homogenising this group risks ignoring those with high levels of social care including that provided by the private sector. However the higher trend in CFS displayed in those in institutional care suggests this was not a major issue within our sample. Using an endpoint of discharge versus death limits mortality analysis, as some of those discharged may subsequently die in the community; however this number is likely lower than would be expected in an older population, as few palliative discharges were made due to limitations on carer visits and return to residential care imposed by the infective nature of COVID-19. Likewise collected biomarker data from patients was sporadic in this population, limiting its use in models of mortality without extensive imputation. Although the spectrum of symptoms seen here with COVID-19 presentation is in keeping with that seen in the general UK population [4], the high proportion of falls, delirium and anorexia suggests prior case reports [6-10] are indicative of a more widespread pattern. The suggestion that COVID-19 presents atypically more f...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.07.07.20148148v1 on medRxiv