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

Loeb, Mark; McGeer, Allison; McArthur, Margaret; Walter, Stephen D.; Simor, Andrew E.

doi:10.1001/archinte.159.17.2058

Cited by 316 publications

(233 citation statements)

References 44 publications

Supporting

Mentioning

206

Contrasting

Unclassified

Order By: Relevance

“…49 The incidence of pneumonia increases with aging, with an almost 6-fold higher incidence in those 75 years old or older compared with those younger than 60 years old. 40,45 In our series, 11% of patients had postoperative aspiration pneumonia that required either antibiotic treatment, readmission to the intensive care unit, or, in 2 cases, prolonged intubation. The natural tendency toward swallowing disorders that occurs with senescence may be further compounded by the potential for injury of the superior laryngeal nerve, the internal branch of which provides sensory innervation to the mucosa of the larynx.…”

Section: Discussionmentioning

confidence: 71%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

114

View full text Add to dashboard Cite

Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

show abstract

Section: Discussionmentioning

confidence: 71%

Anterior fixation of odontoid fractures in an elderly population

Dailey

Hart

Finn

et al. 2010

SPI

114

View full text Add to dashboard Cite

show abstract

“…N ursing home residents frequently develop lower respiratory tract infections, mostly pneumonia and bronchitis, [1][2][3][4][5] with estimated 30-day mortality from pneumonia or lower respiratory tract infection varying between 10% and 30%. 3,[6][7][8][9] Because meaningful cultures from specimens are rarely obtained in practice, 10,11 antibiotic treatment is usually empiric.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Kruse

Mehr²,

Steen³

et al. 2005

The Annals of Family Medicine

View full text Add to dashboard Cite

PURPOSE Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODSWe combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity.RESULTS Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confi dence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefi t from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.

show abstract

“…It is still common among patients with chronic diseases, immune suppressing conditions, or who are submitted to surgical procedures [1,2]. It is also specially incident in elders, either in acute care settings or in nursing homes [3,4]. In all those cases, it has significant impact on morbidity and mortality rates.…”

mentioning

confidence: 99%