After Hospitalization for Pneumonia, Outcomes Are Poor for Many Nursing Home Residents
Pneumonia is a common cause of hospitalization for nursing home (NH) residents, and this has increased during the COVID-19 pandemic. While hospitalization may be necessary and appropriate to manage pneumonia in some residents, what happens when these individuals come back to the nursing home? A study in the December issue of JAMDA suggests that hospitalization for treatment of pneumonia is associated with a significant risk of functional decline and death.
In Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia, the authors found that in 2013 and 2014 nearly 250,000 NH residents were hospitalized for pneumonia, and 89.9% of these experienced severe disability or death following this hospital stay. Such negative outcomes weren’t just limited to those individuals who had pre-hospitalization cognitive and functional deficits. Over half (53%) of residents with no pre-hospitalization functional and cognitive limitations, as well as 82% with no cognitive limitations, had similar outcomes.
“Nursing homes need to prepare for these outcomes in both advance care planning and rehabilitation efforts,” the authors observed. The COVID-19 pandemic has increased the need to address this. Approximately 1 in 3 nursing home residents with COVID-19 has been hospitalized, primarily due to pneumonia symptoms, including cough, fever, and shortness of breath. More than 1 in 4 have died.
The authors suggested, “Our study demonstrates that nursing home admission, particularly with individuals suffering from cognitive and physical limitations, is likely … to initiate advance care planning around the decision to hospitalize for COVID or other pneumonias, as we found that residents are more likely to experience functional decline or death at 60 days following hospitalization than individuals diagnosed with metastatic non-small cell lung cancer.”
This study was conducted by researchers at Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Eastern Colorado Health Care System, Aurora, CO; Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Eastern Colorado Health Care System, Seattle, WA; Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO; Rocky Mountain Senior Care, Golden, CO; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO; Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; and Division of General Internal Medicine, Oregon Health and Science University, Portland, OR.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.