Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

• Published in: Journal of the American Medical Directors Association Vol. 21; no. 12; p. 1879
• Main Authors: Griffith, Matthew F, Levy, Cari R, Parikh, Toral J, Stevens-Lapsley, Jennifer E, Eber, Leslie B, Palat, Sing-I T, Gozalo, Pedro L, Teno, Joan M
• Format: Journal Article
• Language: English
• Published: United States 01.12.2020
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; COVID-19; Female; Functional Status; Hospitalization; Humans; Male; Nursing Homes; Pneumonia - mortality; Retrospective Studies; SARS-CoV-2; United States - epidemiology; United States; COVID-19; functional decline; activities of daily living (ADL); hospitalization; pneumonia
• ISSN: 1538-9375
• DOI: 10.1016/j.jamda.2020.09.010

Pneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. Retrospective cohort study. Participants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. Activities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. In 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. Hospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.