Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in-hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada from March 1, 2020 to June 30, 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n=106, 6.2%). The most common atypical symptoms were anorexia (n=598, 33.5%), weakness (n=519, 23.9%), and delirium (n=449, 25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05, 95% confidence interval [CI] 1.62–2.62), tachycardia (aOR 1.87, 95% CI 1.14–3.04), and delirium (aOR 1.52, 95% CI 1.18–1.96) were independently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presentations in older adults.

中文翻译：

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典型和非典型症状与 COVID-19 老年人住院死亡率的关联：一项多中心队列研究

非典型疾病表现在患有 COVID-19 的老年人中很常见。本研究的目的是通过进行性大流行波确定 COVID-19 老年人非典型和典型症状的患病率，以及这些症状与住院死亡率的关系。这项回顾性队列研究包括 2020 年 3 月 1 日至 2021 年 6 月 30 日期间在加拿大多伦多的七家医院收治的 65 岁以上确诊感染 COVID-19 的连续成年人。1786 名患者的中位年龄为 78.0 岁和 847 (47.5%) 是女性。1187 名患者 (66.5%) 出现非典型症状（定义为老年综合征），但在没有其他症状的情况下很少出现 (n=106, 6.2%)。最常见的非典型症状是厌食（n=598, 33.5%）、虚弱（n=519, 23.9%）和谵妄（n=449, 25.1%）。呼吸困难（调整优势比 [aOR] 2.05, 95% CI 1.62–2.62）、心动过速（aOR 1.87, 95% CI 1.14–3.04）和谵妄（aOR 1.52, 95% CI 1.18–1.96）是独立的与住院死亡率有关。在一组因 COVID-19 感染住院的老年人中，非典型表现经常与典型症状重叠。进一步的研究应旨在了解老年人非典型表现的原因和临床意义。