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Infections and functional impairment in nursing home residents: a reciprocal relationship.
J Am Geriatr Soc. 2004 May; 52(5):700-6.JA

Abstract

OBJECTIVES

To determine the relationship between infections and functional impairment in nursing home residents.

DESIGN

Prospective cohort study (follow-up period, 6 months).

SETTING

Thirty-nine nursing homes in western Switzerland.

PARTICIPANTS

A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent.

MEASUREMENTS

Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure.

RESULTS

At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P=.11). During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.2-2.2, P=.002, and AOR=1.5, 95% CI=1.1-2.0, P=.008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline.

CONCLUSION

Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life.

Authors+Show Affiliations

Division of Geriatric Medicine, Department of Internal Medicine, University of Lausanne, Lausanne, Switzerland. christophe.bula@chuv.hosp.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15086648

Citation

Büla, Christophe J., et al. "Infections and Functional Impairment in Nursing Home Residents: a Reciprocal Relationship." Journal of the American Geriatrics Society, vol. 52, no. 5, 2004, pp. 700-6.
Büla CJ, Ghilardi G, Wietlisbach V, et al. Infections and functional impairment in nursing home residents: a reciprocal relationship. J Am Geriatr Soc. 2004;52(5):700-6.
Büla, C. J., Ghilardi, G., Wietlisbach, V., Petignat, C., & Francioli, P. (2004). Infections and functional impairment in nursing home residents: a reciprocal relationship. Journal of the American Geriatrics Society, 52(5), 700-6.
Büla CJ, et al. Infections and Functional Impairment in Nursing Home Residents: a Reciprocal Relationship. J Am Geriatr Soc. 2004;52(5):700-6. PubMed PMID: 15086648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infections and functional impairment in nursing home residents: a reciprocal relationship. AU - Büla,Christophe J, AU - Ghilardi,Giuseppe, AU - Wietlisbach,Vincent, AU - Petignat,Christiane, AU - Francioli,Patrick, PY - 2004/4/17/pubmed PY - 2004/6/5/medline PY - 2004/4/17/entrez SP - 700 EP - 6 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 52 IS - 5 N2 - OBJECTIVES: To determine the relationship between infections and functional impairment in nursing home residents. DESIGN: Prospective cohort study (follow-up period, 6 months). SETTING: Thirty-nine nursing homes in western Switzerland. PARTICIPANTS: A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent. MEASUREMENTS: Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure. RESULTS: At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P=.11). During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.2-2.2, P=.002, and AOR=1.5, 95% CI=1.1-2.0, P=.008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline. CONCLUSION: Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15086648/Infections_and_functional_impairment_in_nursing_home_residents:_a_reciprocal_relationship_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2004&volume=52&issue=5&spage=700 DB - PRIME DP - Unbound Medicine ER -