Assessment of Pneumonia in Older Adults: Effect of Functional Status

Abstract

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all‐cause 30‐day and 1‐year mortality of adults aged 60 and older and to understand the effect of pneumonia on short‐term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph‐proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty‐four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less‐severe pneumonia per the PPI and shorter mean LOS±standard deviation (5.62±0.51 days) than the FD group (11.42±2.58, P<.004). The FI group had lower 1‐year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24±12.9 vs 4.72±6.55, P<.001). CONCLUSION: Older adults who were FI before admission were more likely to present with less‐severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.

Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups

“…Therefore, more extensive modifications or even an alternative risk score is needed for the evaluation of such patients. Functional disability has repeatedly been shown to be the main predictor of death in this patient population [13,14]. The PSI risk score was shown to perform better when performance status was included [15].…”

Risk and Protective Factors Related to Mortality from Pneumonia among Middleaged and Elderly Community Residents: The JACC Study

“…Adults aged 60 years and older who were functionally independent before admission were reported to be more likely to present with less severe pneumonia symptoms than patients who were functionally dependent before admission. 30 Rather more systematic and detailed surveys will be needed to better elucidate the effects of these aspects of lifestyle.…”

Klinik und Diagnose bronchopulmonaler Infektionen im Alter

“…Spätestens nach 48 Stunden sollte überprüft werden, ob eine klinische Besserung eingetreten ist, im Zweifelsfall sollte die stationäre Einweisung erfolgen [21,68,69]. Kçrperliche Selbstständigkeit des Älteren vor der stationären Einweisung machen einen blanderen Verlauf der Pneumonie mit kürzerer Krankenhausverweildauer wahrscheinlich [70]. Instrumente der Schweregradbestimmung einer CAP sind der CRB-65 (confusion, respiratory rate, blood pressure, Alter 65 J.)…”

“…Instrumente der Schweregradbestimmung einer CAP sind der CRB-65 (confusion, respiratory rate, blood pressure, Alter 65 J.) -Index oder CURB (confusion, urea, respiratory rate, blood pressure) -Index [70,71] (l " Tab. 3).…”