Pneumonia Risk in Institutionalized Older Adults With Severe Functional Dependency: An Exploratory Analysis Using
Yuichi Ohteru1,2,3, Tomoyuki Kakugawa1,2,4, Keita Murakawa3
1Department of Pulmonology and Gerontology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
Aim:
To identify risk factors for pneumonia among institutionalized older adults with severe functional dependency, using routinely available clinical information from the standardized "Doctor's Written Opinion" for long-term care insurance.
Methods:
This retrospective observational study included 257 institutionalized older adults with severe functional dependency (median age, 88 years; 55 men and 202 women) residing in a Japanese nursing home between January 2014 and May 2020. Risk factors for pneumonia were analyzed using medical records and data from the standardized "Doctor's Written Opinion" for long-term care insurance.
Results:
During a median follow-up of 2.1 years, 51 residents (19.8%) developed pneumonia, which was associated with lower overall survival (log-rank test, p = 0.001). Among the 102 residents who died during this period, pneumonia was the most common cause of death (37% of deaths). Multivariate Cox regression analysis revealed male sex (hazard ratio [HR] 4.692, 95% confidence interval [CI] 2.352-9.357), serum albumin level (HR 0.368, 95% CI 0.151-0.898), cognitive ability for daily decision-making (HR 1.626 per one-point worsening on a four-point scale, 95% CI 1.082-2.444), and recent weight loss (≥ 3% over the past 6 months) (HR 2.645, 95% CI 1.195-5.858) as significant risk factors.
Conclusions:
Male sex, lower serum albumin level, impaired cognitive ability for daily decision-making, and recent weight loss were associated with an increased risk of pneumonia. Information routinely available in standardized long-term care assessments may support the identification of individuals at increased risk of pneumonia in resource-limited long-term care settings where comprehensive geriatric assessments are not feasible.
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