Impact of Prompt Influenza Antiviral Treatment on Extended Care Needs After Influenza Hospitalization Among Community-Dwelling Older Adults.
BACKGROUND
Patients hospitalized with influenza may require extended care on discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥ 65 years hospitalized with influenza.


METHODS
We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility on hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤ 4 days) or late (>4 days) in reference to date of illness onset.


RESULTS
Among 6593 community-dwelling adults aged ≥ 65 years hospitalized for influenza, 18% required extended care at discharge. The need for care increased with age and neurologic disorders, intensive care unit admission, and pneumonia were predictors of care needs. Early treatment reduced the odds of extended care after hospital discharge for those hospitalized ≤ 2 or >2 days from illness onset (adjusted odds ratio, 0.38 [95% confidence interval {CI}, .17-.85] and 0.75 [.56-.97], respectively). Early treatment was also independently associated with reduction in length of stay for those hospitalized ≤ 2 days from illness onset (adjusted hazard ratio, 1.81; 95% CI, 1.43-2.30) or >2 days (1.30; 1.20-1.40).


CONCLUSIONS
Prompt antiviral treatment decreases the impact of influenza on older adults through shorten hospitalization and reduced extended care needs.
Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
Sandra S
SS
Chaves
Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
Alejandro
A
Pérez
Colorado Department of Public Health and Environment, Denver.
Lisa
L
Miller
Department of Medicine, University of Rochester School of Medicine and Dentistry, New York.
Nancy M
NM
Bennett
Rhode Island Department of Health, Providence.
Ananda
A
Bandyopadhyay
Department of Medicine, Emory University School of Medicine, Atlanta Atlanta Veterans Affairs Medical Center, Georgia.
Monica M
MM
Farley
Ohio Department of Health, Columbus.
Brian
B
Fowler
New Mexico Department of Health, Santa Fe.
Emily B
EB
Hancock
California Emerging Infections Program, Oakland.
Pam Daily
PD
Kirley
Minnesota Department of Health, St Paul.
Ruth
R
Lynfield
Maryland Department of Health and Mental Hygiene, Baltimore.
Patricia
P
Ryan
Minnesota Department of Health, St Paul.
Craig
C
Morin
Vanderbilt University School of Medicine, Nashville, Tennessee.
William
W
Schaffner
Michigan Department of Community Health, Lansing.
Ruta
R
Sharangpani
Vanderbilt University School of Medicine, Nashville, Tennessee.
Mary Lou
ML
Lindegren
Idaho Department of Health and Welfare, Boise.
Leslie
L
Tengelsen
Oregon Public Health Division, Portland.
Ann
A
Thomas
Salt Lake County Health Department, Utah.
Mary B
MB
Hill
Oklahoma State Department of Health, Oklahoma City.
Kristy K
KK
Bradley
Iowa Department of Public Health, Des Moines.
Oluwakemi
O
Oni
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
James
J
Meek
Emerging Infections Program, New York State Department of Health, Albany.
Shelley
S
Zansky
Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
Marc-Alain
MA
Widdowson
Influenza Division, Centers for Disease Control and Prevention, Atlanta Georgia.
Lyn
L
Finelli
D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy*; D007902:Length of Stay; D008297:Male; D055502:Secondary Prevention; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000998:Antiviral Agents
elderly; extended care; influenza; influenza antiviral treatment; influenza hospitalizations