Risk Factors for Pneumonia and Other Lower Respiratory Tract Infections in Elderly Residents of Long-term Care Facilities

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Abstract
PNEUMONIA AND other lower respiratory tract infections (LRTIs) in elderly residents of long-term care facilities are common and serious. The estimated incidence of pneumonia ranges from 0.6 to 2.6 episodes per 1000 resident-days,1-8 and reported case fatality rates range from 6.5% to 40%.9-14 Pneumonia is the most common reason for transfer of nursing home residents to acute care hospitals; nearly one third of nursing home residents with pneumonia require hospital admission.9,15 To develop appropriate preventive strategies for pneumonia and other LRTIs in long-term care facilities, risk factors need to be well-defined. Limited data exist regarding risk factors for respiratory tract infections in elderly residents of long-term care facilities, and results from previous studies have been conflicting. Variables reported as risk factors include swallowing difficulty, chronic obstructive lung disease, smoking, lack of pneumococcal vaccination, and immobility. Most of these studies, conducted retrospectively, were limited by selection bias and a lack of standardized outcome assessments, had inadequate sample size or follow-up, or did not adjust for confounding variables in the analysis.8,16-20