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%, 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.