Whether to transfer? Factors associated with hospitalization and outcome of elderly long-term care patients with pneumonia.
OBJECTIVE
To determine factors associated with the decision to treat elderly long-term care patients with pneumonia in the hospital vs in the long-term care facility (LTCF) and factors associated with patient outcomes.


METHODS
Retrospective cohort study.


METHODS
Hebrew Rehabilitation Center for Aged.


METHODS
Nursing home residents who had an episode of pneumonia, defined as a new respiratory sign or symptom and a new infiltrate.


RESULTS
The majority of the 316 pneumonia episodes (78%) were managed in the LTCF, most (77%) with oral antibiotics. Both patient-related factors, such as elevated respiratory rate, and non-patient-related factors, such as evening evaluation, were associated with hospitalization. No patient who had a do-not-hospitalize (DNH) order was hospitalized. Equal proportions of patients given LTCF therapy (87%) and hospital therapy (88%) survived. Elevated respiratory rate was associated with dying from pneumonia in the LTCF but not in the hospital. Dependent functional status was associated with dying from pneumonia in both sites.


CONCLUSIONS
Many episodes of pneumonia can be managed in the LTCF with oral antibiotics. Because, in the absence of DNH orders, both patient-related and non-patient-related factors are associated with hospital transfer, discussion regarding preferences for hospitalization should occur prior to the development of an acute illness. A high respiratory rate may be a good marker for those LTCF patients requiring hospitalization. Dependent functional status may be a good marker for those LTCF patients unlikely to benefit from hospital transfer.
Fried
T R
TR
Division of Geriatrics, Rhode Island Hospital, Providence 02903, USA.
Gillick
M R
MR
Lipsitz
L A
LA
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D010360:Patient Transfer; D011014:Pneumonia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012119:Respiration; D012189:Retrospective Studies; D012307:Risk Factors