title: Prospective cohort study of fever incidence and risk in elderly persons living at home.
abstract: OBJECTIVE
  To determine the incidence of fever among elderly persons under home medical management, diagnosis at fever onset and outcomes from a practical standpoint.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  5 clinics in residential areas of Tokyo that process an average of 50-200 outpatients/day.
  
  
  METHODS
  Patients (n=419) aged ≥65 years who received home medical management from the five clinics between 1 October 2009 and 30 September 2010.
  
  
  METHODS
  Fever (≥37.5°C or ≥1.5°C above usual body temperature), diagnosis at onset and outcomes (cure at home, hospitalisation and death).
  
  
  RESULTS
  The incidence of fever was 2.5/1000 patient-days (95% CI 2.2 to 2.8). Fever occurred at least once (229 fever events) among one-third of the participants during the study period. Fever was more likely to arise in the wheelchair users or bedridden than in ambulatory individuals (HR 1.9 (95% CI 1.3 to 2.8; p<0.01); in patients with moderate-to-severe rather than those with none-to-mild cognitive impairment (HR, 1.7 (95% CI 1.1 to 2.6, p=0.01); and in those whose care-need levels were ≥3 rather than ≤2 (HR, 4.5 (95% CI 2.9 to 7.0; p<0.01). The causes of fever were pneumonia/bronchitis (n=103), skin and soft tissue infection (n=26), urinary tract infection (n=22) and the common cold (n=13). Fever was cured in 67% and 23% of patients at home and in hospital, respectively, and 5% of patients each died at home and in hospital. Antimicrobial agents treated 153 (67%) events in the home medical care setting.
  
  
  CONCLUSIONS
  Fever was more likely to occur in those requiring higher care levels and the main cause of fever was pneumonia/bronchitis. Healthcare providers should consider the conditions of elderly residents with lower objective functional status.
authors.affiliation: Department of General Internal Medicine, Hiroshima University of Medical Science, Hiroshima, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yokobayashi
authors.affiliation: Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Kita-adachi Seikyo Clinic, Tokyo Hokuto Health Co-operative, Tokyo, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Fujinuma
authors.affiliation: Department of General Internal Medicine, Hiroshima University of Medical Science, Hiroshima, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Tazuma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology*; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications; D008297:Male; D011014:Pneumonia; D011446:Prospective Studies; D018570:Risk Assessment
keywords: General Medicine (see Internal Medicine); Geriatric Medicine