Community-Acquired Pneumonia Among the Elderly: Differences Between Patients Living at Home and in Nursing Homes

Nursing home-acquired pneumonia: a 10 year single-centre experience

“…In contrast, many studies on NHAP9 11 28 and the recent North American series on HCAP report higher mortality rates (up to 40%) 15 16. Interestingly, the Spanish study by Carratalà on HCAP, including 32 NH patients (25.4% of all HCAP), shows a mortality rate very close to that of this study (10.3% for HCAP and 4% for CAP) 17.…”

“…In contrast, two prospective European studies described Streptococcus pneumoniae and Haemophilus influenzae as the most frequent pathogens in NHAP 9 11 17…”

“…Much information has been gathered on NHAP since the 1970s6–8: patients with NHAP are usually elderly, with multiple diseases (eg, cardiovascular, respiratory and neurological) and poor functional status 9–11. The clinical presentation of NHAP is often unusual,6 7 9 12 13 with frequent extrapulmonary manifestations (mental confusion and gastrointestinal disorders),14 and the clinical presentation may be worse than in community-acquired pneumonia (CAP) (eg, hypoxaemia and altered consciousness) 11 15 16. The mortality rate of NHAP is close to that of hospital-acquired pneumonia (HAP)7 9 11 15–17 (20–40%), while its annual incidence is 30-fold that of the general population and 11-fold that for the elderly (≥75 years) 4 7 18 19…”

Lower Barthel Index Is Associated with Higher Risk of Hospitalization-Requiring Pneumonia in Long-Term Care Facilities

“…Although NHAP has similar pathophysiology and microbiology as community-acquired pneumonia (CAP), the two entities should be distinguished for the different patient characters and outcomes (Martinez-Moragon et al 2004;Raghavendran et al 2007). The incidences of NHAP varied from 0.3 to 2.3 episodes per 1,000 person-days in the elderly LTCF individuals, which are significantly higher than that of CAP in the community-based population (Muder 1998;Mylotte 2002).…”

“…Among the elderly patients who are admitted due to pneumonia, those live in LTCFs tend to be older and frailer with lower BI, and have more medical burden such as multiple comorbidities and dementia. They also have tendency towards "atypical presentations" of pneumonia and worse vital signs and survival rates comparing with those live in the communities (Janssens and Krause 2004;Martinez-Moragon et al 2004;Raghavendran et al 2007). The mortality rates of patients with NHAP are reported as 32%-57% (Janssens and Krause 2004), which is significantly higher in the NHAP patients who needs hospitalization for treatment than those treatment in the LTCFs (Raghavendran et al 2007).…”