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Ann Rehabil Med  <  Volume 21(4); 2017 <  Articles

Ann Geriatr Med Res 2017; 21(4): 158-163  https://doi.org/10.4235/agmr.2017.21.4.158
Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease
Yu Jin Jung1, Jong Lull Yoon2, Hak Sun Kim1, Ae-Young Lee1, Mee Young Kim2, Jung Jin Cho2
1Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 2Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
Correspondence to: Jong Lull Yoon, MD, PhD
Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong 18450, Korea
Tel: +82-31-8086-2370
Fax:+82-31-8086-2242
E-mail: lull@hallym.ac.kr
Received: August 1, 2017; Revised: October 26, 2017; Accepted: October 26, 2017; Published online: December 31, 2017.
© The Korea Geriatrics Society. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Atypical symptoms often occur in elderly patients due to impaired homeostasis associated with age-related physiological changes and multiple pathologies. These atypical symptoms make diagnosis difficult and may partially increase morbidity and mortality. This study aimed to determine the incidence of atypical clinical presentation and to identify the effects of age and comorbidities on illness presentation in the elderly.
Methods: Medical charts of 6,057 elderly patients (≥60 years) with pneumonia or coronary artery disease (CAD) admitted to 4 university hospitals were retrospectively reviewed. Determinants of atypical symptom presentation was evaluated using logistic regression analysis. The definition of atypical presentation was adapted from a previous study on atypical symptoms of pneumonia and CAD.
Results: Among the 6,057 participants, 4,773 (78.8%) and 1,284 (21.2%) presented with typical and atypical symptoms, respectively. Among the participants, 24.8% CAD and 18.8% pneumonia patients had atypical presentations. Logistic regression analysis showed that factors associated with atypical presentation in CAD patients were age (≥85 years; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.81-4.03), higher pulse rate (OR, 1.01; 95% CI, 1.00-1.01), and number of comorbidities ≥4 (OR, 1.62; 95% CI, 1.13-2.32). In pneumonia patients, age (≥85 years; OR, 2.22; 95% CI, 1.49-3.31), body mass index (OR, 0.97; 95% CI, 0.94-0.99), and 1 comorbidity (OR, 1.53; 95% CI, 1.01-2.36) were statistically significant factors that increased atypical presentation.
Conclusion: This study suggested that older patients frequently present atypical geriatric syndrome with acute illness, and age and comorbidity are statistically significant factors associated with atypical symptoms in CAD or pneumonia patients.
Keywords: Geriatric syndrome, Atypical symptom, Older, Pneumonia, Coronary artery disease


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