Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

Joy E. van Son*, Elisabeth C.P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W.M. Jansen, Anita Lekx, Carolien M.J. van der Linden, Roy Looman, Huub A.A.M. Maas, Francesco U.S. Mattace-Raso, Simon P. Mooijaart, Barbara C. van Munster, Annefleur Peters, Harmke A. Polinder-Bos, Rosalinde A.L. Smits, Petra E. Spies, Anna WassenburgNora Wassenburg, Hanna C. Willems, Henrike J. Schouten, Sarah H.M. Robben

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation. Methods: We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality. Results: We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76–86 years; versus 79 years, IQR 74–84, p = 0.044) and were more often classified as severely frail (CFS 6–9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34–1.0); p = 0.058]. Conclusions: In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.

Original languageEnglish
Pages (from-to)333-343
Number of pages11
JournalEuropean Geriatric Medicine
Issue number2
Early online date7 Feb 2023
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
We would like to thank Annemarie Verburg and Marianne van Nistelrooij (Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn & Zutphen, the Netherlands); Greetje Emmerik (Department of Geriatric Medicine, Reinier de Graaf Hospital, Delft, the Netherlands); Orla Smit (Department of Internal Medicine, Division of Geriatric Medicine, Zaans Medisch Centrum, Zaandam, the Netherlands); Esmee Mulder and Milou Spekreijse (Department of Geriatric Medicine, Catharina Hospital, Eindhoven, the Netherlands); and Leanne Oosterwijk (Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands) for their assistance with data collection. Furthermore, we would like to thank Marjan Wieringa (Department of Education, Office of Science, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands) for her assistance with the statistical analysis.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to European Geriatric Medicine Society.


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