RT Journal
A1 Loeb M, McGeer A, McArthur M, Walter S, Simor AE
T1 RIsk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD September 27
VO 159
IS 17
SP 2058
OP 2064
DO 10.1001/archinte.159.17.2058
UL http://dx.doi.org/10.1001/archinte.159.17.2058
AB 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.