With infections increasing once more, and hospitalization rising among older adults, health experts offer a timely warning: a coronavirus infection can look different in older patients.   by Paula Span / NYTimes / August 8, 2021

One day in March of 2020, Rosemary Bily suddenly grew so tired she could barely get out of bed. “She slept a lot,” said her son-in-law Rich Lamanno. “She was wiped out for most of a month.” Ms. Bily, now 86, also developed nausea and diarrhea, along with a slight cough, and subsisted mostly on Tylenol and Gatorade.

A few days later her husband, Eugene Bily, 90, started coughing and became lethargic as well.

Had it not been for a family gathering a few days earlier, the children of the Bilys would not have suspected the new coronavirus. They might have blamed the flu, or simply advancing age. “What we heard on TV was ‘high fever, can’t breathe’ — and they had neither,” Mr. Lamanno recalled.

But about a dozen guests had gathered at a restaurant in Rockville Centre, Long Island, earlier that month to celebrate a niece’s birthday, and one by one most of them fell ill with Covid, including Mr. Lamanno and his wife.

As the symptoms spread, doctors told the worried family that the Bilys most likely had Covid-19. Because tests were in short supply at the time, neither was tested; the family also feared taking them to overflow local hospitals. But subsequent antibody tests confirmed that Eugene and Rosemary Bily, who live in Oceanside, N. Y., had contracted and survived the virus.

The population over 65, most vulnerable to the virus’s effects, got an early start on Covid vaccination and has the highest rate in the country — more than 80 percent are fully vaccinated. But with infections increasing once more, and hospitalization rising among older adults, a large-scale new study in the Journals of Gerontology provides a timely warning: Covid can look different in older patients.

“People expect fever, cough, shortness of breath,” said Allison Marziliano, lead author of the study. She is a social and health psychologist at the Feinstein Institutes for Medical Research, part of the large Northwell Health system across New York State.

But when the researchers combed through the electronic health records of nearly 5,000 people, all over the age of 65, who were hospitalized for Covid at a dozen Northwell hospitals in March and April of 2020, they found that one-third had arrived with other symptoms, unexpected ones.

The team, searching through records using language software, found that about one-quarter of older patients reported a functional decline. “This was falls, fatigue, weakness, difficulty walking or getting out of bed,” Dr. Marziliano said.

Eleven percent experienced altered mental status — “confusion, agitation, forgetfulness, lethargy,” she said. About half the group with atypical symptoms also suffered from at least one of the classic Covid problems — fever, trouble breathing, coughing.

“Clinicians should know, older adults should know, their caregivers should know: If you see certain atypical symptoms, it could be Covid,” Dr. Marziliano said.

The rate of atypical symptoms rose significantly with age, affecting about 31 percent of those aged 65 to 74, but more than 44 percent of those over 85. These symptoms occurred more commonly in women, in Black patients (but not in Hispanics) and in those who had other chronic diseases, particularly diabetes or dementia.

Because people in the atypical group were less likely to experience breathing problems and require ventilation, they were less likely to need intensive care. But both groups spent about 10 days in the hospital, and roughly one-third of each group died.

“These people were in the hospital for as long,” Dr. Marziliano said. “Their mortality rate was as high. So this shouldn’t be dismissed.”