The burden of respiratory infections among older adults in long-term care: a systematic review

Arielle Childs,Patience Moyo,Kevin W Mcconeghy,Andrew R Zullo,Stefan Gravenstein,Elliott Bosco,Nina R Joyce,Robertus Van Aalst,Vincent Mor

doi:10.1186/s12877-019-1236-6

Abstract

BackgroundRespiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. To address the critical need for evidence regarding the global burden of respiratory infections in LTCFs, we assessed the burden of respiratory infections in LTCFs through a systematic review of the published literature.MethodsWe identified articles published between April 1964 and March 2019 through searches of PubMed (MEDLINE), EMBASE, and the Cochrane Library. Experimental and observational studies published in English that included adults aged ≥60 residing in LTCFs who were unvaccinated (to identify the natural infection burden), and that reported measures of occurrence for influenza, respiratory syncytial virus (RSV), or pneumonia were included. Disagreements about article inclusion were discussed and articles were included based on consensus. Data on study design, population, and findings were extracted from each article. Findings were synthesized qualitatively.ResultsA total of 1451 articles were screened for eligibility, 345 were selected for full-text review, and 26 were included. Study population mean ages ranged from 70.8 to 90.1 years. Three (12%) studies reported influenza estimates, 7 (27%) RSV, and 16 (62%) pneumonia. Eighteen (69%) studies reported incidence estimates, 7 (27%) prevalence estimates, and 1 (4%) both. Seven (27%) studies reported outbreaks. Respiratory infection incidence estimates ranged from 1.1 to 85.2% and prevalence estimates ranging from 1.4 to 55.8%. Influenza incidences ranged from 5.9 to 85.2%. RSV incidence proportions ranged from 1.1 to 13.5%. Pneumonia prevalence proportions ranged from 1.4 to 55.8% while incidence proportions ranged from 4.8 to 41.2%.ConclusionsThe reported incidence and prevalence estimates of respiratory infections among older LTCF residents varied widely between published studies. The wide range of estimates offers little useful guidance for decision-making to decrease respiratory infection burden. Large, well-designed epidemiologic studies are therefore still necessary to credibly quantify the burden of respiratory infections among older adults in LTCFs, which will ultimately help inform future surveillance and intervention efforts.

Highlights

Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the long-term care facility (LTCF) setting is lacking
Older adults residing in long-term care facilities (LTCFs) are an important subset of the older adult population that is at high risk of respiratory infections
No literature was identified on the outcomes or costs of developing a respiratory infection in LTCFs

Summary

Introduction

Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. From the years 2012 to 2050, the size of the population of individuals ≥65 years is expected to double [7] This growth creates a critical need to better understand the burden of respiratory infections in older adults [7]. Around 5% or more of persons ≥65 years are in LTCFs in developed countries, and LTCF use is rapidly growing in developing countries [8, 9] These LTCFs house individuals in close quarters, an important consideration for contagious respiratory infections [10, 11]. The close proximity of residents in combination with advanced age, multimorbidity and frailty in LTCFs likely predisposes older adults to an even greater susceptibility to infections and their complications [12]. The LTCF setting and its residents are important targets for research and interventions [11]

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