title: Infections and functional impairment in nursing home residents: a reciprocal relationship.
abstract: OBJECTIVE
  To determine the relationship between infections and functional impairment in nursing home residents.
  
  
  METHODS
  Prospective cohort study (follow-up period, 6 months).
  
  
  METHODS
  Thirty-nine nursing homes in western Switzerland.
  
  
  METHODS
  A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent.
  
  
  METHODS
  Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure.
  
  
  RESULTS
  At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P=.11). During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.2-2.2, P=.002, and AOR=1.5, 95% CI=1.1-2.0, P=.008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline.
  
  
  CONCLUSIONS
  Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life.
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland. christophe.bula@chuv.hosp.ch
authors.forename: Christophe J
authors.initials: CJ
authors.lastname: Büla
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ghilardi
authors.forename: Vincent
authors.initials: V
authors.lastname: Wietlisbach
authors.forename: Christiane
authors.initials: C
authors.lastname: Petignat
authors.forename: Patrick
authors.initials: P
authors.lastname: Francioli
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D007114:Immunization; D007239:Infections / Q000150:complications* / Q000401:mortality; D008297:Male; D009735:Nursing Homes; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012141:Respiratory Tract Infections / Q000150:complications / Q000401:mortality; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000401:mortality