Incidence and economical effects of pneumonia in the older population living in French nursing homes: design and methods of the INCUR study

BMC Public Health

Matteo Cesari²  Bruno Vellas²  Marilyne Duboué¹  Delphine Pennetier¹  Stéphane Gérard¹  Yves Rolland²  Laurent Demougeot¹ 

[1] Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France;INSERM UMR 1027, Université Paul Sabatier - Toulouse III, Toulouse, France

关键词: Health care;    Physical disability;    Pneumonia;    Nursing home;    Older adults;   

Others  :  1161763
DOI  :  10.1186/1471-2458-13-861

 received in 2013-02-01, accepted in 2013-09-11,  发布年份 2013

【 摘 要 】

Background

Among the most burdensome clinical conditions occurring in older persons, respiratory infections are particularly relevant. In fact, the onset of pneumonias is associated with a significant worsening of the individual’s global health status and significant increase of healthcare costs. The clinical and economical negative consequences of pneumonia may be particularly evident among the frailest groups of elders, in particular those living in nursing home. Nevertheless, specific research on incidence and economical effects of pneumonia in nursing homes residents is still scarce. In the present article, we present the rationale, the design and the methods of the “Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study, specifically aimed at filling some of the gaps currently present in the field.

Methods/design

INCUR is an observational longitudinal study recruiting 800 residents across 13 randomly selected nursing homes in France. Multidimensional evaluations of participants are conducted at the baseline, mid-term (at 6 months), and end of the study (at 12 months) visits in order to measure and follow-up their physical function, nutrition, cognition, depression, quality of life, and healthcare costs. Incident pneumonia as well as the onset/recurrence of other major health-related events are monitored during the study follow-up.

Discussion

The INCUR study will provide valuable information about older persons living in nursing homes. Results from INCUR study may constitute the basis for the development of future preventive campaigns against pneumonia and its consequences.

【 授权许可】

   
2013 Demougeot et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Christensen K, Doblhammer G, Rau R, Vaupel JW: Ageing populations: the challenges ahead. Lancet 2009, 374:1196-1208.
• [2]Thomas DR, Rolland Y, Morley JE: Nursing home care. In Pathy’s principles and practice of geriatric medicine. 1 & 2, Fifth edition. Edited by Sinclair AJ, Morley JE, Vellas B. Hoboken, New Jersey: John Wiley & Sons, Ltd; 2012:1697-1708.
• [3]Sonnefeld ST, Waldo DR, Lemieux JA, McKusick DR: Projections of national health expenditures through the year 2000. Health Care Financ Rev 1991, 13:1-15.
• [4]Rolland Y, Abellan van Kan G, Hermabessiere S, Gerard S, Guyonnet Gillette S, Vellas B: Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 2009, 13:679-683.
• [5]El-Solh AA: Nursing home acquired pneumonia: approach to management. Curr Opin Infect Dis 2011, 24:148-151.
• [6]Scott IA, Guyatt GH: Cautionary tales in the interpretation of clinical studies involving older persons. Arch Intern Med 2010, 170:587-595.
• [7]Dybicz SB, Thompson S, Molotsky S, Stuart B: Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother 2011, 9:212-223.
• [8]Lee PG, Cigolle C, Blaum C: The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. J Am Geriatr Soc 2009, 57:511-516.
• [9]Rolland Y, Andrieu S, Crochard A, Goni S, Hein C, Vellas B: Psychotropic drug consumption at admission and discharge of nursing home residents. J Am Med Dir Assoc 2012, 13:407.e7-407.e12.
• [10]Tamura BK, Bell CL, Inaba M, Masaki KH: Factors associated with polypharmacy in nursing home residents. Clin Geriatr Med 2012, 28:199-216.
• [11]Lester P, Haq M, Vadnerkar A, Feuerman M: Falls in the nursing home setting: does time matter? J Am Med Dir Assoc 2008, 9:684-686.
• [12]Bourdel-Marchasson I: How to improve nutritional support in geriatric institutions. J Am Med Dir Assoc 2010, 11:13-20.
• [13]Fried TR, Bradley EH, Williams CS, Tinetti ME: Functional disability and health care expenditures for older persons. Arch Intern Med 2001, 161:2602-2607.
• [14]Van der Maarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, De Baat C: Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc 2011, 12:344-354.
• [15]Murray CJ, Lopez AD: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997, 349:1436-1442.
• [16]Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004, 52:625-634.
• [17]Van der Steen JT, Mehr DR, Kruse RL, Ribbe MW, Van der Wal G: Treatment strategy and risk of functional decline and mortality after nursing-home acquired lower respiratory tract infection: two prospective studies in residents with dementia. Int J Geriatr Psychiatry 2007, 22:1013-1019.
• [18]Kruse RL, Mehr DR, Van der Steen JT, Ooms ME, Madsen RW, Sherman AK, D’Agostino RB, Van der Wal G, Ribbe MW: Antibiotic treatment and survival of nursing home patients with lower respiratory tract infection: a cross-national analysis. Ann Fam Med 2005, 3:422-429.
• [19]High KP: Chronic infection and frailty: surrogate markers, associations, and causality. J Am Geriatr Soc 2005, 53:906-908.
• [20]Gavazzi G, Krause K-H: Ageing and infection. Lancet Infect Dis 2002, 2:659-666.
• [21]Fagan M, Mæhlen M, Lindbæk M, Berild D: Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines. Scand J Prim Health Care 2012, 30:10-15.
• [22]Warren JW, Palumbo FB, Fitterman L, Speedie SM: Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991, 39:963-972.
• [23]Van Buul LW, Van der Steen JT, Veenhuizen RB, Achterberg WP, Schellevis FG, Essink RTGM, Van Benthem BHB, Natsch S, Hertogh CMPM: Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc 2012, 13:568.e1-568.e13.
• [24]High KP: Infection as a cause of age-related morbidity and mortality. Ageing Res Rev 2004, 3:1-14.
• [25]Mehr DR, Binder EF, Kruse RL, Zweig SC, Madsen R, Popejoy L, D’Agostino RB: Predicting mortality in nursing home residents with lower respiratory tract infection: The Missouri LRI Study. JAMA 2001, 286:2427-2436.
• [26]Fulop T, Pawelec G, Castle S, Loeb M: Immunosenescence and vaccination in nursing home residents. Clin Infect Dis 2009, 48:443-448.
• [27]Quagliarello V, Juthani-Mehta M, Ginter S, Towle V, Allore H, Tinetti M: Pilot testing of intervention protocols to prevent pneumonia in nursing home residents. J Am Geriatr Soc 2009, 57:1226-1231.
• [28]Ahmed AA, Hays CI, Liu B, Aban IB, Sims RV, Aronow WS, Ritchie CS, Ahmed A: Predictors of in-hospital mortality among hospitalized nursing home residents: an analysis of the National Hospital Discharge Surveys 2005-2006. J Am Med Dir Assoc 2010, 11:52-58.
• [29]Abellan Van Kan G, Sinclair A, Andrieu S, Olde Rikkert M, Gambassi G, Vellas B: The geriatric minimum data set for clinical trials (GMDS). J Nutr Health Aging 2008, 12:197-200.
• [30]Abellan Van Kan G, Andrieu S, Vellas B: GerontoNet: a network of excellence for clinical trials with geriatric patients. J Nutr Health Aging 2007, 11:251-253. discussion 250
• [31]Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963, 185:914-919.
• [32]Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9:179-186.
• [33]Rabin R, De Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001, 33:337-343.
• [34]Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146-M156.
• [35]Hodkinson HM: Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972, 1:233-238.
• [36]Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17:37-49.
• [37]Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL: The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999, 15:116-122.
• [38]Rothan-Tondeur M, Piette F, Lejeune B, De Wazieres B, Gavazzi G: Infections in nursing homes: is it time to revise the McGeer criteria? J Am Geriatr Soc 2010, 58:199-201.
• [39]McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, Peppler C, Rivera A, Schollenberger DG, Simor AE: Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991, 19:1-7.
• [40]Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49:M85-M94.
• [41]Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000, 55:M221-M231.
• [42]Brinkley TE, Leng X, Miller ME, Kitzman DW, Pahor M, Berry MJ, Marsh AP, Kritchevsky SB, Nicklas BJ: Chronic inflammation is associated with low physical function in older adults across multiple comorbidities. J Gerontol A Biol Sci Med Sci 2009, 64:455-461.
• [43]Cesari M, Penninx BWJH, Pahor M, Lauretani F, Corsi AM, Rhys Williams G, Guralnik JM, Ferrucci L: Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004, 59:242-248.
• [44]Cesari M, Onder G, Zamboni V, Manini T, Shorr RI, Russo A, Bernabei R, Pahor M, Landi F: Physical function and self-rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study. BMC Geriatr 2008, 8:34.
• [45]Cesari M, Onder G, Russo A, Zamboni V, Barillaro C, Ferrucci L, Pahor M, Bernabei R, Landi F: Comorbidity and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Gerontology 2006, 52:24-32.
• [46]Rolland Y, Lauwers-Cances V, Cesari M, Vellas B, Pahor M, Grandjean H: Physical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol 2006, 21:113-122.
• [47]Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L: Midlife hand grip strength as a predictor of old age disability. JAMA 1999, 281:558-560.
• [48]Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM: Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc 2003, 51:636-641.
• [49]Kruse RL, Boles KE, Mehr DR, Spalding D, Lave JR: The cost of treating pneumonia in the nursing home setting. J Am Med Dir Assoc 2003, 4:81-89.
• [50]Dosa D: Should I hospitalize my resident with nursing home-acquired pneumonia? J Am Med Dir Assoc 2006., 7S74–80, 73
• [51]Szafara KL, Kruse RL, Mehr DR, Ribbe MW, Van der Steen JT: Mortality following nursing home-acquired lower respiratory infection: LRI severity, antibiotic treatment, and water intake. J Am Med Dir Assoc 2012, 13:376-383.
• [52]De Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, Vellas B, Rolland Y: A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: research protocol and baseline data of the IQUARE study. J Nutr Health AgingIn Press
• [53]Middleton DB, Lin CJ, Smith KJ, Zimmerman RK, Nowalk MP, Roberts MS, Fox DE: Economic evaluation of standing order programs for pneumococcal vaccination of hospitalized elderly patients. Infect Control Hosp Epidemiol 2008, 29:385-394.