Abstract
BackgroundOlder 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.MethodsIn 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.ResultsWe 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.ConclusionsShort-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.
Highlights
Older adults who reside in long-term care facilities (LTCFs) are at 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
Particular focus on P&I among LTCF residents, whether short- or long-stay, is especially warranted given that close living quarters and shared caregivers found in an institutional environment can increase the risk of exposure to infections and rate of transmission [10]
Prior research focused on P&I hospitalization among LTCF residents has been limited in the number and geographic distribution of facilities examined [5, 6, 11], and most existing studies overlook the distinction between short- and long-stay LTCF residents in their analyses [12,13,14]
Summary
Older adults who reside in long-term care facilities (LTCFs) are at 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. Older adults (≥65 years of age) in long-term care facilities (LTCFs) have a high risk of infection, hospitalization, and death due to respiratory infections such as pneumonia and influenza (P&I) [1,2,3,4]. Prior research focused on P&I hospitalization among LTCF residents has been limited in the number and geographic distribution of facilities examined [5, 6, 11], and most existing studies overlook the distinction between short- and long-stay LTCF residents in their analyses [12,13,14]. Short-stay residents typically require rehabilitative nursing immediately following hospitalization, whereas long-stay residents predominantly receive custodial and chronic care services [18]
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