title: Morbidity, mortality and clinical presentation of nursing home-acquired pneumonia in a Swedish population.
abstract: Pneumonia has been estimated to be the second most common infection in nursing-home residents. However, to the authors' knowledge, no such Swedish data are available. Therefore, this study investigated the incidence, risk factors, and 30 d case-fatality rate and clinical presentation of nursing home-acquired pneumonia (NHAP) in 234 nursing-home residents aged 66-99 y. Activities of daily living (ADL status), malnutrition and body mass index were measured at baseline. The residents were then followed prospectively during 1 y for symptoms and signs of pneumonia. Pneumonia was verified clinically and/or radiologically in 32 residents, corresponding to a yearly incidence of 13.7%. The 30 d case-fatality rate was 28%. Cough and sputum production were the most specific, and fever > or = 38.0 degrees C rectally and cognitive decline were the most common non-specific presenting symptoms. Chronic obstructive pulmonary disease, ADL status > 5 and male gender were risk factors for acquiring pneumonia. In conclusion, NHAP is associated with high morbidity and mortality in Sweden. In order not to delay treatment, it is necessary to be aware that specific symptoms of pneumonia may be lacking in the clinical presentation in the nursing-home setting.
authors.affiliation: Department of Medicine and Care, Faculty of Health Sciences, University of Linköping, Linköping, Sweden. marsu@imv.liu.se
authors.forename: Märtha
authors.initials: M
authors.lastname: Sund-Levander
authors.forename: Ake
authors.initials: A
authors.lastname: Ortqvist
authors.forename: Ewa
authors.initials: E
authors.lastname: Grodzinsky
authors.forename: Orjan
authors.initials: O
authors.lastname: Klefsgård
authors.forename: Lis Karin
authors.initials: LK
authors.lastname: Wahren
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology*; D016001:Confidence Intervals; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009017:Morbidity / Q000639:trends; D015999:Multivariate Analysis; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology