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Pneumonia and Lower Respiratory Infections in Nursing Home Residents: Predictors of Hospitalization and Mortality

Authors

  • Soo B. Chan Carusone PhD,

    1. From the Departments of *Clinical Epidemiology and BiostatisticsPathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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  • Stephen D. Walter PhD,

    1. From the Departments of *Clinical Epidemiology and BiostatisticsPathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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  • Kevin Brazil PhD,

    1. From the Departments of *Clinical Epidemiology and BiostatisticsPathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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  • Mark B. Loeb MD, MSc

    1. From the Departments of *Clinical Epidemiology and BiostatisticsPathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Address correspondence to Dr. Mark Loeb, McMaster University, MDCL 3200, 1200 Main Street, W. Hamilton, ON, L8N 3Z5 Canada. E-mail: loebm@mcmaster.ca

Abstract

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

DESIGN: A nested cohort study.

SETTING: Nine nursing homes in southern Ontario.

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

MEASUREMENTS: 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.

CONCLUSION: In nursing home residents with LRI, severity of illness and radiographically confirmed pneumonia are predictive of death and hospitalization.

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