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Risk Factors for Pneumonia and Other Lower Respiratory Tract Infections in Elderly Residents of Long-term Care Facilities
Mark Loeb, MD;
Allison McGeer, MD;
Margaret McArthur, RN;
Stephen Walter, PhD;
Andrew E. Simor, MD
Arch Intern Med. 1999;159:2058-2064.
Background Little is known about the risk factors, outcome, and impact of pneumonia and other lower respiratory tract infections (LRTIs) in residents of long-term care facilities.
Objective To determine the risk factors and the effect of these infections on functional status and clinical course.
Methods Active surveillance for these infections was conducted for 475 residents in 5 nursing homes from July 1, 1993, through June 30, 1996. Information regarding potential risk factors for these infections, functional status, transfers to hospital, and death was also obtained.
Results Two hundred seventy-two episodes of pneumonia and other LRTIs occurred in 170 residents during 228,757 days of surveillance for an incidence of 1.2 episodes per 1000 resident-days. Multivariable analysis revealed that older age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6 per 10-year interval; P=.01), male sex (OR, 1.9; 95% CI, 1.1-3.5; P=.03), swallowing difficulty (OR, 2.0; 95% CI, 1.2-3.3; P=.01), and the inability to take oral medications (OR, 8.3; 95% CI, 1.4-50.3; P=.02) were significant risk factors for pneumonia; receipt of influenza vaccine (OR, 0.4; 95% CI, 0.3-0.5; P=.01) was protective. Age (OR, 1.6 [95% CI, 1.0-2.5] per 10-year interval; P=.05) and immobility (OR, 2.6; 95% CI, 1.8-3.8; P=.01) were significant risk factors for other LRTIs, and influenza vaccination was protective (OR, 0.3; 95% CI, 0.2-0.4; P=.01). Residents with pneumonia (OR, 0.7; 95% CI, 0.3-1.4; P=.31) or with other LRTIs (OR, 0.5; 95% CI, 0.2-1.1; P=.43) were no more likely to have a deterioration in functional status than individuals in whom infection did not develop.
Conclusions Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities. Our findings challenge the commonly held belief that pneumonia leads to long-term decline in functional status in this population.
From the Division of Infectious Diseases, Department of Laboratory Medicine, Hamilton Health Sciences Corporation (Dr Loeb), and the Department of Clinical Epidemiology and Biostatistics (Dr Walter), McMaster University, Hamilton; the Department of Microbiology and the Division of Infectious Diseases, Mount Sinai and Princess Margaret Hospitals (Dr McGeer and Ms McArthur), the Department of Laboratory Medicine and Pathobiology, University of Toronto (Drs McGeer and Simor), and the Baycrest Centre for Geriatric Care (Dr Simor), Toronto; and the Department of Microbiology and the Division of Infectious Diseases, Sunnybrook and Women's College Health Sciences Centre, North York (Dr Simor), Ontario.
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