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Here we assess LRTI symptom profiles and syndromic (symptom-based) case ascertainment in older (\u2265\u200965y) as compared to younger adults (<\u200965y).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We included adults (\u2265\u200918y) with confirmed LRTI admitted to two acute care Trusts in Bristol, UK from 1st August 2020- 31st July 2022. Logistic regression was used to assess whether age\u2009\u2265\u200965y reduced the probability of meeting syndromic LRTI case definitions, using patients\u2019 symptoms at admission. We also calculated relative symptom frequencies (log-odds ratios) and evaluated how symptoms were clustered across different age groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 17,620 clinically confirmed LRTI cases, 8,487 (48.1%) had symptoms meeting the case definition. Compared to those not meeting the definition these cases were younger, had less severe illness and were less likely to have received a SARS-CoV-2 vaccination or to have active SARS-CoV-2 infection. Prevalence of dementia\/cognitive impairment and levels of comorbidity were lower in this group.<\/jats:p>\n After controlling for sex, dementia and comorbidities, age\u2009\u2265\u200965y significantly reduced the probability of meeting the case definition (aOR\u2009=\u20090.67, 95% CI:0.63\u20130.71). Cases aged\u2009\u2265\u200965y were less likely to present with fever and LRTI-specific symptoms (e.g., pleurisy, sputum) than younger cases, and those aged\u2009\u2265\u200985y were characterised by lack of cough but frequent confusion and falls.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n LRTI symptom profiles changed considerably with age in this hospitalised cohort. Standard screening protocols may fail to detect older and frailer cases of LRTI based on their symptoms.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12879-024-09425-7","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T01:01:48Z","timestamp":1717722108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Syndromic case definitions for lower respiratory tract infection (LRTI) are less sensitive in older age: an analysis of symptoms among hospitalised 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Available from: https:\/\/www.health.org.uk\/news-and-comment\/charts-and-infographics\/understanding-the-needs-and-experiences-of-those-most-clinic. Cited 2024 Mar 25."}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-024-09425-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-024-09425-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-024-09425-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T17:13:31Z","timestamp":1759166011000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-024-09425-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["9425"],"URL":"https:\/\/doi.org\/10.1186\/s12879-024-09425-7","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,7]]},"assertion":[{"value":"6 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Funding section has been updated to include a missing grant number.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Health Research Authority Research Ethics Committee East of England, Essex, reference 20\/EE\/0157. Informed consent was obtained from cognisant patients, and declarations for participation from consultees for individuals lacking capacity. Patients who declined consent were not included in this analysis. For individuals for whom an approach to seek consent could not be made, data were included with approval from the Clinical Advisory Group (20\/CAG\/0138).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publications"}},{"value":"CH is Principal Investigator of the AvonCAP study, a University of Bristol sponsored study which is funded by Pfizer. JO is a Co-Investigator on the AvonCAP Study. AF is a member of the UK Dept of Health, Joint Committee on Vaccination and Immunization (JCVI) and, until December 2022, was chair of the World Health Organization European Technical Advisory Group of Experts on Immunization (ETAGE). In addition to receiving funding for this study from Pfizer as Chief Investigator, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation and is chief or principal investigator in current or recent COVID-19 vaccine trials funded by Astra-Zeneca, Valneva and Sanofi. LD, RC are also partly funded through AvonCAP. LD is a Co-Investigator of the AvonCAP study and has also received funding from Pfizer, UKRI and UKHSA for unrelated projects. RK holds an honorary contract with the UK Health Security Agency (UKHSA). The corresponding author had full access to all data in the study and final responsibility for the decision to submit for publication. All the other authors do not have any competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"568"}}