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Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia
  1. Radhika Rastogi1,
  2. Pei-Chun Yu2,
  3. Abhishek Deshpande3,
  4. Ardeshir Z Hashmi4,
  5. Shoshana J Herzig5,6,
  6. Michael B Rothberg3
  1. 1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  6. 6Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Michael B Rothberg, Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH 44124, USA; rothbem{at}ccf.org

Abstract

Our objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65–74. This was a retrospective cohort study. The study setting included 638 hospitals in the USA participating in the Premier database from 2010 to 2015. The study participants were 488,382 adults aged ≥65 years hospitalized with CAP. Patients ≥85 years were more likely to be white (79.8% vs 76.2%), female (58.1% vs 48.3%), and admitted with aspiration pneumonia (17.1% vs 7.0%) as compared with those aged 65–75 years. They had higher rates of dementia (30.4% vs 7.8%), but lower rates of diabetes (11.2% vs 17.6%) and chronic obstructive pulmonary disease (25.5% vs 54.7%). While Staphylococcus aureus (33.4%) was the most common pathogen across all age groups, patients aged ≥85 were more likely to have Escherichia coli pneumonia (16.1% vs 10.7%) compared with those aged 65–74. In adjusted models, patients aged ≥85 had greater in-hospital mortality (OR 1.14, 95% CI 1.11 to 1.18), but were less likely to be admitted to the intensive care unit (OR 0.54, 95% CI 0.53 to 0.55) and receive mechanical ventilation (OR 0.47, 95% CI 0.46 to 0.48). They also had lower rates of acute kidney injury (OR 0.95, 95% CI 0.91 to 1.00) and Clostridium difficile infection (OR 0.91, 95% CI 0.85 to 0.99), shorter lengths of stay (mean multiplier 0.93, 95% CI 0.92 to 0.93) and lower cost (mean multiplier 0.81, 95% CI 0.80 to 0.81), and were more likely to be discharged to a skilled nursing facility (OR 2.19, 95% CI 2.15 to 2.24) or hospice (OR 2.19, 95% CI 2.11 to 2.27). In conclusion, patients aged ≥85 have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.

  • lung diseases
  • pneumonia
  • respiratory system
  • respiratory tract diseases

Data availability statement

No data are available.

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Footnotes

  • Presented at Some results were presented by AD as an abstract at IDWeek 2019, Washington, DC.

  • Contributors RR: substantial contribution to conception and design, interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. P-CY: substantial contribution to the analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. AD: substantial contribution to conception and design, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. AZH: substantial contribution to conception and design, revising it critically for important intellectual content, and final approval of the version to be published. SJH: substantial contribution to interpretation of data, revising it critically for important intellectual content, and final approval of the version to be published. MBR: substantial contribution to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published.

  • Funding This study was funded by a grant from the Agency for Healthcare Research and Quality (R01HS024277).

  • Disclaimer The funder had no role in the research or publication.

  • Competing interests P-CY, AD, and MBR were supported by funds from the Agency for Healthcare Research and Quality (R01HS024277).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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