PURPOSE: CAP is a significant cause of morbidity among the elderly. Previous work by the investigators suggest 1) functional decline is common early post discharge and 2) many patients require higher level of care at discharge. Phenomena associated with aftermath of inpatient episodes have not been well studied. Investigators measured functional decline post discharge in a cohort of elderly patients hospitalized with CAP with focus on follow-up to examine sequelae of a CAP episode as they relate to health-related QOL measures.
METHODS: CAP patients ≥70 years with positive findings on chest radiography were enrolled consecutively from a medical floor at a tertiary care teaching institution from 7/04 to 2/06. We developed consent document approved by Institutional Review Board. Medical records were reviewed by trained abstractors to assess clinical course, comorbidities, and demographics. Patients were surveyed by telephone at 6weeks, and 6 and 9 months post discharge utilizing SF-36 and a set of questions about health status.
RESULTS: 53 patients were enrolled in the study (24 females, 29 males) with a mean age of 82.8 years (standard deviation: 7.2). Median length of stay (LOS), estimated using traditional survival methods (the Kaplan-Meier product limit method), was 7 days (95% confidence interval 6-8 days). Average number of comorbidities was 4.8 (SD:2.6.). At 6 weeks post discharge, of 33 subjects contacted 49% reported their general health as good/very good, 42% reported fair,and 9% reported poor. At 9 months post discharge, of 25 subjects contacted 40% reported their general health as good/very good, 40% reported fair, and 20% reported as poor. The readmission rate was 14% at 6 weeks, and 32% at 9 months.
CONCLUSION: Admission for pneumonia in elderly is a life defining event. Many patients after an admission for CAP continue to report a significant deterioration in their health status. There was a significant readmission rate post discharge impacting morbidity.
CLINICAL IMPLICATIONS: Amongst the elderly population, comprehensive management of CAP should also include convalescent phase post discharge to improve outcomes.
DISCLOSURE: Arunabh Talwar, None.