Article

Pneumonia and Influenza Hospitalizations in Elderly People with Dementia

Department of Public Health and Family Medicine, School of Medicine, Tufts University, Boston, MA 02111,
Journal of the American Geriatrics Society (Impact Factor: 4.57). 10/2009; 57(12):2192-9. DOI: 10.1111/j.1532-5415.2009.02565.x
Source: PubMed

ABSTRACT

To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I.
Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources.
Retrospective analysis of medical records uniformly collected over a 5-year period with comprehensive national coverage.
A study population representative of more than 95% of all people aged 65 and older residing in the continental United States.
Six million two hundred seventy-seven thousand six hundred eighty-four records of P&I between 1998 and 2002 were abstracted, and county-specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county-specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed.
Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average.
The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment.

0 Followers
 · 
15 Reads
  • Source
    • "Nursing homes with a larger bed size predicted better quality of care (Harrington & Swan, 2003; Li, 2010); however, another study found that a smaller bed size was associated with better quality (Wan et al., 2006). A higher level of nursing staff often predicted better quality in several studies (Naumova et al., 2009; Spector et al., 2007; Wan et al., 2006), but higher staffing level also predicted negative outcomes as measured by infections (Zimmerman et al., 2002). The provision of special care programs (e.g., intravenous therapy) predicted fewer hospitalizations, but other programs such as onsite x-ray had little effect (Intrator et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.
    Full-text · Article · Jun 2011 · The Gerontologist
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In temperate regions, influenza epidemics occur annually with the highest activity occurring during the winter months. While seasonal dynamics of the influenza virus, such as time of onset and circulating strains, are well documented by the Centers for Disease Control and Prevention Influenza Surveillance System, an accurate prediction of timing, magnitude, and composition of circulating strains of seasonal influenza remains elusive. To facilitate public health preparedness for seasonal influenza and to obtain better insights into the spatiotemporal behavior of emerging strains, it is important to develop measurable characteristics of seasonal oscillation and to quantify the relationships between those parameters on a spatial scale. The objectives of our research were to examine the seasonality of influenza on a national and state level as well as the relationship between peak timing and intensity of influenza in the United States older adult population.
    Full-text · Article · Apr 2010 · PLoS ONE
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This analysis examines the potential for the elderly to receive indirect protection from pneumonia and influenza (P&I) from vaccination of children. Using data from the Centers for Medicare and Medicaid Services, the National Immunization Survey, and the Behavioral Risk Factor Surveillance System, mixed-effects models were used to assess associations between vaccination coverage and P&I on the state level overall and by urbanicity and income. As vaccination coverage in children increased, the state-level P&I rates in seniors decreased (beta=-0.040, -0.074 to 0.006), where beta represents the expected change in the logged age-associated rate of disease increase for a one-percentage point increase in vaccination coverage. Increasing vaccination coverage in the elderly was associated with an increase in P&I rates (beta=0.045, 0.011-0.077) in seniors. The degree of association was more prominent in urban and high income areas. The consistent associations between influenza in the elderly and vaccination coverage in children suggest that routine vaccination of children may impart some indirect protection to the elderly.
    Full-text · Article · May 2010 · Vaccine
Show more