Whether to transfer? Factors associated with hospitalization and outcome of elderly long-term care patients with pneumonia

J Gen Intern Med. 1995 May;10(5):246-50. doi: 10.1007/BF02599879.


Objective: To determine factors associated with the decision to treat elderly long-term care patients with pneumonia in the hospital vs in the long-term care facility (LTCF) and factors associated with patient outcomes.

Design: Retrospective cohort study.

Setting: Hebrew Rehabilitation Center for Aged.

Patients: Nursing home residents who had an episode of pneumonia, defined as a new respiratory sign or symptom and a new infiltrate.

Measurements and main results: The majority of the 316 pneumonia episodes (78%) were managed in the LTCF, most (77%) with oral antibiotics. Both patient-related factors, such as elevated respiratory rate, and non-patient-related factors, such as evening evaluation, were associated with hospitalization. No patient who had a do-not-hospitalize (DNH) order was hospitalized. Equal proportions of patients given LTCF therapy (87%) and hospital therapy (88%) survived. Elevated respiratory rate was associated with dying from pneumonia in the LTCF but not in the hospital. Dependent functional status was associated with dying from pneumonia in both sites.

Conclusions: Many episodes of pneumonia can be managed in the LTCF with oral antibiotics. Because, in the absence of DNH orders, both patient-related and non-patient-related factors are associated with hospital transfer, discussion regarding preferences for hospitalization should occur prior to the development of an acute illness. A high respiratory rate may be a good marker for those LTCF patients requiring hospitalization. Dependent functional status may be a good marker for those LTCF patients unlikely to benefit from hospital transfer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Chi-Square Distribution
  • Cohort Studies
  • Decision Making
  • Female
  • Homes for the Aged*
  • Hospitalization*
  • Humans
  • Logistic Models
  • Long-Term Care
  • Male
  • Nursing Homes*
  • Patient Transfer*
  • Pneumonia / mortality
  • Pneumonia / physiopathology
  • Pneumonia / therapy*
  • Prognosis
  • Respiration
  • Retrospective Studies
  • Risk Factors