Atypical Presentations among Older Adults with COVID-19 Disease: A Need for Broadening the Differential Diagnosis

Typical presenting symptoms of COVID-19 have been reported to be common in older adults. Current guidelines by the World Health Organization (WHO) and Centers for Disease Control (CDC) for testing and diagnosis are based on the presence of these typical symptoms. Several older adults seen at our hospital have presented atypically with symptoms such as delirium, falls, increasing the need for attention to diagnostic protocols since this has significant implications for early detection and patient outcomes, infection control and promotion of safety among healthcare providers. With the increased risk of fatality among older adults with COVID-19, appropriate diagnostic protocols are needed to ensure early diagnosis and management. Recognizing these atypical presentations in nursing homes would also facilitate early screening and cohorting in these congregate living facilities where older adults have had disproportionately high morbidity and mortality rates. We present two patients who presented with delirium and falls, found to have COVID-19 infection.