Long-term care level as a predictor of a poor outcome in elderly patients with pneumonia

Abstract

To determine factors associated with physical decline and a poor prognosis after hospitalization in physically dependent elderly patients with acute pneumonia. The subjects included 112 geriatric patients (86.8±5.5 years old) with acute pneumonia consecutively admitted to an inpatient unit of Geriatric Medicine, Kyorin University Hospital in the period from April 2012 to March 2013. All patients were generally treated with broad-spectrum antibiotics according to nursing- and healthcare-associated pneumonia (NHCAP) guidelines. The patients' baseline severity of pneumonia was evaluated according to the A-Drop score and their physical dependency was assessed according to the JABC score before and after admission. The patients were categorized into the community acquired pneumonia group (CAP) (n=29) and NHCAP group (n=83). The patients in the NHCAP group had a longer hospital stay (NHCAP vs. CAP: 33 vs. 21 days, p=0.02), higher A-Drop scores (2.88±0.80 vs. 2.45±0.87 points, p=0.02) and were more frequently diagnosed with aspiration pneumonia (89.2% vs. 42.9%, p<0.0001) than those in the CAP group. Three patients in the CAP group (10.3%) and 13 patients in the NHCAP group (15.7%) died during their hospital stay (p=0.69). Although the rest of the patients were successfully treated for pneumonia, their physical dependency progressed after admission in both groups (p<0.0001). After adjusting for age, gender and the JABC score before admission, NHCAP (risk ratio against CAP: 6.2, 95% CI 1.2-32.2, p=0.03) and a serum albumin lower than 2.5 g/dl (RR: 7.8, 95%CI 1.7-35.7, p<0.01) were significantly associated with the progression of physical dependency after admission. The diagnosis of NHCAP is a risk factor for the progression of physical dependency. Therefore, palliative care may be an optional approach for frail patients.