Pneumonia and lower respiratory infections in nursing home residents: predictors of hospitalization and mortality

J Am Geriatr Soc. 2007 Mar;55(3):414-9. doi: 10.1111/j.1532-5415.2007.01070.x.


Objectives: To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs).

Design: A nested cohort study.

Setting: Nine nursing homes in southern Ontario.

Participants: Three hundred fifty-three nursing home residents with LRIs (enrolled in the control arm of a clinical trial).

Measurements: Comorbidities, vaccination status, age, health-related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days.

Results: Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P<.001) and mortality (OR=5.04, P=.003). Diagnosis of pneumonia, established using chest radiograph, was also associated with hospitalization (OR=2.43, P=.008) and mortality (OR=2.35, P=.02). Oxygen saturation (<90%) was a strong independent predictor of hospitalization (OR=3.02, P=.004) but was not a significant predictor of mortality in multivariable analyses. Diagnosis of congestive heart failure (OR=2.26, P=.02) was an independent predictor of hospitalization, whereas receipt of pneumococcal vaccine (OR=0.36, P=.01) and greater functional independence (OR=0.92, P=.02) were negatively associated with hospitalization.

Conclusion: In nursing home residents with LRI, severity of illness and radiographically confirmed pneumonia are predictive of death and hospitalization.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living / classification
  • Aged
  • Aged, 80 and over
  • Critical Pathways
  • Female
  • Geriatric Assessment / statistics & numerical data
  • Heart Failure / mortality
  • Homes for the Aged / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nursing Homes / statistics & numerical data*
  • Ontario
  • Pneumonia, Bacterial / mortality*
  • Pneumonia, Bacterial / therapy
  • Quality of Life
  • Risk Factors
  • Statistics as Topic
  • Survival Analysis