Pneumonia and lower respiratory infections in nursing home residents: predictors of hospitalization and mortality.
OBJECTIVE
To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs).


METHODS
A nested cohort study.


METHODS
Nine nursing homes in southern Ontario.


METHODS
Three hundred fifty-three nursing home residents with LRIs (enrolled in the control arm of a clinical trial).


METHODS
Comorbidities, vaccination status, age, health-related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days.


RESULTS
Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P<.001) and mortality (OR=5.04, P=.003). Diagnosis of pneumonia, established using chest radiograph, was also associated with hospitalization (OR=2.43, P=.008) and mortality (OR=2.35, P=.02). Oxygen saturation (<90%) was a strong independent predictor of hospitalization (OR=3.02, P=.004) but was not a significant predictor of mortality in multivariable analyses. Diagnosis of congestive heart failure (OR=2.26, P=.02) was an independent predictor of hospitalization, whereas receipt of pneumococcal vaccine (OR=0.36, P=.01) and greater functional independence (OR=0.92, P=.02) were negatively associated with hospitalization.


CONCLUSIONS
In nursing home residents with LRI, severity of illness and radiographically confirmed pneumonia are predictive of death and hospitalization.
Chan Carusone
Soo B
SB
Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Walter
Stephen D
SD
Brazil
Kevin
K
Loeb
Mark B
MB
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009864:Ontario; D018410:Pneumonia, Bacterial / Q000401:mortality* / Q000628:therapy; D011788:Quality of Life; D012307:Risk Factors; D013223:Statistics as Topic; D016019:Survival Analysis