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Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

BACKGROUND: Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I ho...

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Autores principales: Moyo, Patience, Zullo, Andrew R., McConeghy, Kevin W., Bosco, Elliott, van Aalst, Robertus, Chit, Ayman, Gravenstein, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011520/
https://www.ncbi.nlm.nih.gov/pubmed/32041538
http://dx.doi.org/10.1186/s12877-020-1457-8
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author Moyo, Patience
Zullo, Andrew R.
McConeghy, Kevin W.
Bosco, Elliott
van Aalst, Robertus
Chit, Ayman
Gravenstein, Stefan
author_facet Moyo, Patience
Zullo, Andrew R.
McConeghy, Kevin W.
Bosco, Elliott
van Aalst, Robertus
Chit, Ayman
Gravenstein, Stefan
author_sort Moyo, Patience
collection PubMed
description BACKGROUND: Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person- and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015. METHODS: In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100,000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models. RESULTS: We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short- and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents. CONCLUSIONS: Short-stay residents had lower crude 30- and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short- and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk.
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spelling pubmed-70115202020-02-14 Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study Moyo, Patience Zullo, Andrew R. McConeghy, Kevin W. Bosco, Elliott van Aalst, Robertus Chit, Ayman Gravenstein, Stefan BMC Geriatr Research Article BACKGROUND: Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person- and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015. METHODS: In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100,000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models. RESULTS: We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short- and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents. CONCLUSIONS: Short-stay residents had lower crude 30- and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short- and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk. BioMed Central 2020-02-10 /pmc/articles/PMC7011520/ /pubmed/32041538 http://dx.doi.org/10.1186/s12877-020-1457-8 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Moyo, Patience
Zullo, Andrew R.
McConeghy, Kevin W.
Bosco, Elliott
van Aalst, Robertus
Chit, Ayman
Gravenstein, Stefan
Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title_full Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title_fullStr Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title_full_unstemmed Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title_short Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
title_sort risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011520/
https://www.ncbi.nlm.nih.gov/pubmed/32041538
http://dx.doi.org/10.1186/s12877-020-1457-8
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