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Pneumonia and influenza – specific considerations in care homes

Published online by Cambridge University Press:  02 March 2010

Adam Gordon*
Affiliation:
Division of Rehabilitation & Ageing, University of Nottingham Medical School, Queens Medical Centre, Nottingham, UK
Victoria Ewan
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
*
Address for correspondence: Dr Adam Gordon, Clinical Lecturer in Medicine of Older People, Room B98, Division of Rehabilitation & Ageing, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UH. Email: adam.gordon@nottingham.ac.uk

Summary

This review provides an update on current evidence surrounding epidemiology, treatment and prevention of lower respiratory tract infection, with special reference to pneumonia and influenza, in care home residents. The care home sector is growing and provides a unique ecological niche for infections, housing frail older people with multiple co-morbidities and frequent contact with healthcare services. There are therefore considerations in the epidemiology and management of these conditions that are specific to care homes. Opportunities for prevention, in the form of vaccination strategies and improving oral hygiene, may reduce the burden of these diseases in the future. Work is needed to research these infections specifically in the care home setting, and this article highlights current gaps in our knowledge.

Type
Intermediate care and rehabilitation
Copyright
Copyright © Cambridge University Press 2010

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References

1Ribbe, MW, Ljunggren, G, Steel, K et al. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing 1997; 26: 312.CrossRefGoogle Scholar
2Bajekal, M.Health Survey for England 2000: Characteristics of Care Homes and Their Residents. London: The Stationary Office; 2002.Google Scholar
3Falconer, M, O'Neill, D. Profiling disability within nursing homes: a census-based approach. Age Ageing 2007; 36: 209–13.Google Scholar
4US Centre for Disease Control and Prevention. National Nursing Home Survey. 2004 (cited 30 November 2009); available at: http://www.cdc.gov/nchs/nnhs/nnhs_products.htmGoogle Scholar
5Huang, J-J, Lin, K-C, Li, I-C. Service needs of residents in community-based long-term care facilities in northern Taiwan. J Clin Nursing 2008; 17: 99108.CrossRefGoogle ScholarPubMed
6Bowman, C, Whistler, J, Ellerby, M. A national census of care home residents. Age Ageing 2004; 33: 561–66.CrossRefGoogle ScholarPubMed
7Nicolle, LE, McLeod, J, McIntyre, M, MacDonell, JA. Significance of pharyngeal colonization with aerobic gram-negative bacilli in elderly institutionalized men. Age Ageing 1986; 15: 4752.Google Scholar
8Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996; 9: 117.Google Scholar
9Terpenning, M, Shay, K. Oral health is cost-effective to maintain but costly to ignore [comment]. J Am Geriat Soc 2002; 50: 584–85.Google Scholar
10El-Solh, AA, Sikka, P, Ramadan, F, Davies, J. Etiology of severe pneumonia in the very elderly. Am J Resp Crit Care Med 2001; 163: 645–51.CrossRefGoogle ScholarPubMed
11El Solh, AA, Saliba, R. Pharmacologic prevention of aspiration pneumonia: a systematic review. Am J Geriat Pharmacother 2007; 5: 352–62.CrossRefGoogle ScholarPubMed
12El Solh, AA, Pietrantoni, C, Bhat, A et al. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis 2004; 39: 474–80.CrossRefGoogle ScholarPubMed
13Kollef, MH, Shorr, A, Tabak, YP et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128: 3854–62.Google Scholar
14Lim, WS, Macfarlane, JT. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. Eur Resp J 2001; 18: 362–68.CrossRefGoogle ScholarPubMed
15Degelau, J, Guay, D, Straub, K et al. Effectiveness of oral antibiotic treatment in nursing home-acquired pneumonia. J Am Geriatr Soc 1995; 43: 245–51.CrossRefGoogle ScholarPubMed
16El Solh, AA, Akinnusi, ME, Alfarah, Z et al. Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia. J Am Geriatr Soc 2009; 57: 1030–35.Google Scholar
17Yoneyama, T, Yoshida, M, Ohrui, T et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50: 430–33.Google Scholar
18Quagliarello, V, Ginter, S, Han, L et al. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis 2005; 40: 16.Google Scholar
19Engelhart, ST, Hanses-Derendorf, L, Exner, M, Kramer, MH. Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect 2005; 60: 4650.CrossRefGoogle ScholarPubMed
20van Der Steen, JT, Mehr, DR, Kruse, RL et al. 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 Psychiat 2007; 22: 1013–19.Google Scholar
21Nuorti, JP, Butler, JC, Crutcher, JM et al. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. New Eng J Med 1998; 338: 1861–68.Google Scholar
22Quick, RE, Hoge, CW, Hamilton, DJ et al. Underutilization of pneumococcal vaccine in nursing homes in Washington state: Report of a serotype-specific outbreak and a survey. Am J Med 1993; 94: 149–52.Google Scholar
23Nicholson, KG, Wood, JM, Zambon, M. Influenza. The Lancet 2003; 362: 1733–45.Google Scholar
24Loeb, M, McGeer, A, McArthur, M et al. Surveillance for outbreaks of respiratory tract infections in nursing homes. Can Med Assoc J 2000; 162: 1133–37.Google ScholarPubMed
25Hayward, AC, Harling, R, Wetten, S et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. Br Med J 2006; 333: 1241–46.Google Scholar
26Serie, C, Barme, M, Hannoun, C et al. Effects of vaccination on an influenza epidemic in a geriatric hospital. Dev Biol Standardization 1977; 39: 317–21.Google Scholar
27Meiklejohn, G, Hall, H. Unusual outbreak of influenza A in a Wyoming nursing home. J Am Geriatr Soc 1987; 35: 742–46.Google Scholar
28Saah, AJ, Neufeld, R, Rodstein, M et al. Influenza vaccine and pneumonia mortality in a nursing home population. Archives Int Med 1986; 146: 2353–57.CrossRefGoogle Scholar
29Thompson, WW, Shay, DK, Weintraub, E et al. Influenza-associated hospitalizations in the United States. J Am Med Assoc 2004; 292: 1333–40.Google Scholar
30Brankston, G, Gitterman, L, Hirji, Z, Lemieux, C, Gardam, M. Transmission of influenza A in human beings. Lancet Infect Dis 2007; 7: 257–65.Google Scholar
31Jefferson, T, Foxlee, R, Mar, CD et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. Br Med J 2008; 336: 7780.Google Scholar
32Cowling, BJ, Chan, K-H, Fang, VJ et al. Facemasks and hand hygiene to prevent influenza transmission in households. Ann Intern Med 2009; 151: 437–46.Google Scholar
33Pandemic Influenza: Guidance for infection control in hospitals and primary care settings. London, Department of Health, 2007.Google Scholar
34Nicolle, L. Infection control in long term care facilities. Clin Infect Dis 2000; 31: 752–56.CrossRefGoogle ScholarPubMed
35Harkness, GA, Bentley, DW, Roghmann, KJ. Risk factors for nosocomial pneumonia in the elderly. Am J Med 1990; 89: 457–63.Google Scholar
36Lim, WS, Van Der Eerden, MM, Laing, R et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377–82.CrossRefGoogle ScholarPubMed
37Fine, MJ, Auble, TE, Yealy, DM et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. New Eng J Med 1997; 336: 243–50.Google Scholar
38Morley, JE, Silver, AJ. Nutritional issues in nursing home care. Ann Internat Med 1995; 123: 850–59.CrossRefGoogle ScholarPubMed
39Preston, AJ, Gosney, MA, Noon, S, Martin, MV. Oral flora of elderly patients following acute medical admission. Gerontology 1999; 45: 4952.CrossRefGoogle ScholarPubMed
40Russell, SL, Boylan, RJ, Kaslick, RS, Scannapieco, FA, Katz, RV. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentistry 1999; 19: 128–34.CrossRefGoogle ScholarPubMed
41Leibovitz, A, Plotnikov, G, Habot, B, Rosenberg, M, Segal, R. Pathogenic colonization of oral flora in frail elderly patients fed by nasogastric tube or percutaneous enterogastric tube. J Gerontol Ser A Biol Sci Med Sci 2003; 58: 5255.Google Scholar
42Leibovitz, A, Plotnikov, G, Habot, B et al. Saliva secretion and oral flora in prolonged nasogastric tube-fed elderly patients. Israel Med Assoc J 2003; 5: 329–32.Google Scholar
43Herzig, SJ, Howell, MD, Ngo, LH et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. J Am Med Assoc 2009; 301: 2120–28.CrossRefGoogle ScholarPubMed
44Laheij, RJ, Sturkenboom, MC, Hassing, RJ et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. J Am Med Assoc 2004; 292: 1955–60.Google Scholar
45Gavazzi, G, Krause, K-H. Ageing and infection. Lancet Infect Dis 2002; 2: 659–66.Google Scholar
46Hutt, E, Kramer, AM, Hutt, E, Kramer, AM. Evidence-based guidelines for management of nursing home-acquired pneumonia. J Family Pract 2002; 51: 709–16.Google Scholar
47Hui, DS, Woo, J, Hui, E et al. Influenza-like illness in residential care homes: a study of the incidence, aetiological agents, natural history and health resource utilisation. Thorax 2008; 63: 690–97.CrossRefGoogle Scholar
48Myint, PK, Kamath, AV, Vowler, SL, Maisey, DN, Harrison, BDW. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing 2006; 35: 286–91.Google Scholar
49Loeb, MB, Carusone, SB, Marrie, TJ et al. Interobserver reliability of radiologists’ interpretations of mobile chest radiographs for nursing home-acquired pneumonia. J Am Med Director Assoc 2006; 7: 416–19.Google Scholar
50Masterton, RG, Galloway, A, French, G et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2008; 62: 534.CrossRefGoogle Scholar
51Scannapieco, FA, Bush, RB, Paju, S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Annals Periodontol 2003; 8: 5469.CrossRefGoogle ScholarPubMed
52Azarpazhooh, A, Leake, JL, Azarpazhooh, A, Leake, JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006; 77: 1465–82.Google Scholar
53Yoneyama, T, Yoshida, M, Matsui, T, Sasaki, H. Oral care and pneumonia. Oral Care Working Group. Lancet 1999; 354: 515.CrossRefGoogle ScholarPubMed
54Bassim, CW, Gibson, G, Ward, T et al. Modification of the risk of mortality from pneumonia with oral hygiene care. J Am Geriatr Soc 2008; 56: 1601–7.Google Scholar
55Loeb, MB, Becker, M, Eady, A, Walker-Dilks, C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc 2003; 51: 1018–22.CrossRefGoogle ScholarPubMed
56Andrews, RM, Counahan, ML, Hogg, GG et al. Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria, Australia. Vaccine 2004; 23: 132–38.Google Scholar
57Dominguez, A, Salleras, L, Fedson, DS et al. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clin Infect Dis 2005; 40: 1250–57.Google Scholar
58Konradsen, HB, Konradsen, HB. Quantity and avidity of pneumococcal antibodies before and up to five years after pneumococcal vaccination of elderly persons. Clin Infect Dis 1995; 21: 616–20.CrossRefGoogle ScholarPubMed
59Skull, SA, Andrews, RM, Byrnes, GB et al. Prevention of community-acquired pneumonia among a cohort of hospitalized elderly: benefit due to influenza and pneumococcal vaccination not demonstrated. Vaccine 2007; 25: 4631–40.Google Scholar
60Huss, A, Scott, P, Stuck, AE, Trotter, C, Egger, M. Efficacy of pneumococcal vaccination in adults: A meta-analysis. Can Med Assoc J 2009; 180: 4858.Google Scholar
61Jefferson, T. Pneumococcal vaccines: confronting the confounders. Lancet 2009; 373: 2008–9.Google Scholar
62van Essen, GA, Palache, AM, Forleo, E, Fedson, DS. Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries. Vaccine 2003; 21: 1780–85.Google Scholar
63World Health Organization. Influenza vaccines: recommendations for the use of inactivated influenza vaccines and other preventive measures. Weekly Epidemiol Record 2000; 75: 281–88.Google Scholar
64Demicheli, V, Di Pietrantonj, C, Jefferson, T, Rivetti, A, Rivetti, D. Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews 2007; (2): available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001269/frame.htmlCrossRefGoogle Scholar
65Monto, AS, Hornbuckle, K, Ohmit, SE. Influenza vaccine effectiveness among elderly nursing home residents: a cohort study. Am J Epidemiol 2001; 154: 155–60.Google Scholar
66Ohmit, SE, Arden, NH, Monto, AS. Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic. J Am Geriatr Soc 1999; 47: 165–71.Google Scholar
67Foster, DA, Talsma, A, Furumoto-Dawson, A et al. Influenza vaccine effectiveness in preventing hospitalization for pneumonia in the elderly. Am J Epidemiol 1992; 136: 296307.Google Scholar
68Monto, AS, Ansaldi, F, Aspinall, R et al. Influenza control in the 21st century: Optimizing protection of older adults. Vaccine 2009; 27: 5043–53.Google Scholar
69Goodwin, K, Viboud, C, Simonsen, L. Antibody response to influenza vaccination in the elderly: A quantitative review. Vaccine 2006; 24: 1159–69.Google Scholar
70Carman, WF, Elder, AG, Wallace, LA et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000; 355: 9397.Google Scholar
71Thomas, RE, Jefferson, T, Demicheli, V, Rivetti, D. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database of Systematic Reviews 2006; (3): available at: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005187/frame.htmlGoogle Scholar
72Begum, F, Pebody, R. Summary report: influenza vaccination uptake for healthcare workers (HCWs) in England. Winter season 2008/09. Available at: http://www.immunisation.nhs.uk/publications/FluVaccineUptake_HCW_Winter0809.pdfGoogle Scholar
73Looijmans-van den Akker, I, van Delden, JJM, Hak, E. Uptake of influenza vaccination in Dutch nursing home personnel following national recommendations. J Am Geriatr Soc 2007; 55: 1486–87.Google Scholar
74Sand, KL, Lynn, J, Bardenheier, B, Seow, H, Nace, DA. Increasing influenza immunization for long-term care facility staff using quality improvement. J Am Geriatr Soc 2007; 55: 1741–47.CrossRefGoogle ScholarPubMed
75Hofmann, F, Ferracin, C, Marsh, G, Dumas, R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006; 34: 142–47.Google Scholar
76Jordan, R, Hayward, A. Should healthcare workers have the swine flu vaccine? Br Med J 2009; 339: b3398.CrossRefGoogle ScholarPubMed
77van Delden, JJM, Ashcroft, R, Dawson, A et al. The ethics of mandatory vaccination against influenza for health care workers. Vaccine 2008; 26: 5562–66.Google Scholar
78Peters, PH, Gravenstein, S, Norwood, P et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc 2001; 49: 1025–31.Google Scholar
79Ambrozaitis, A, Gravenstein, S, van Essen, GA et al. Inhaled zanamivir versus placebo for the prevention of influenza outbreaks in an unvaccinated long-term care population. J Am Med Directors Assoc 2005; 6: 367–74.Google Scholar
80National Institute of Clinical Excellence. TA158 Influenza (prophylaxis) – amantadine, oseltamivir and zanamivir: guidance. Available at: http://guidanceniceorguk/TA158/Guidance/pdf/English (accessed 1 Nov 2009).Google Scholar
81USA Centre for Disease Control and Prevention. CDC Issues Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses, 2008–09 Influenza Season. Available at: http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279 (accessed 30 Oct 2009).Google Scholar
82Moscona, A. Oseltamivir resistance – disabling our influenza defenses. New Eng J Med 2005; 353: 2633–36.Google Scholar
83Diggory, P, Fernandez, C, Humphrey, A, Jones, V, Murphy, M. Comparison of elderly people's technique in using two dry powder inhalers to deliver zanamivir: randomised controlled. Br Med J 2001; 322: 577.Google Scholar
84Garb, JL, Brown, RB, Garb, JR et al. Differences in etiology of pneumonias in nursing home and community patients. J Am Med Assoc 1978; 240: 2169–72.Google Scholar
85Kneeland, Y Jr, Price, KM. Antibiotics and terminal pneumonia. A postmortem microbiological study. Am J Med 1960; 29: 967–79.CrossRefGoogle ScholarPubMed
86Johanson, WG, Dever, LL. Nosocomial pneumonia. Intensive Care Med 2003; 29: 2329.Google Scholar
87Brito, V, Niederman, MS. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Curr Opin Infect Dis 2009; 22: 316–25.Google Scholar
88American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Crit Care Med 2005; 171: 388416.CrossRefGoogle Scholar
89Burch, J, Corbett, M, Stock, C et al. Prescription of anti-influenza drugs for healthy adults: a systematic review and meta-analysis. Lancet Infect Dis 2009; 9: 537–45.Google Scholar
90National Institute of Clinical Excellence. TA168 Influenza – zanamivir, amantadine and oseltamivir (review): guidance. Available at: http://http://guidanceniceorguk/TA168/Guidance/pdf/English (accessed 1 Nov 2009).Google Scholar
91Cohen, D. Complications: tracking down the data on oseltamivir. Br Med J 2009; 339: b5387.CrossRefGoogle ScholarPubMed
92UK Health Protection Agency. Pandemic flu: Clinical management of patients with an influenza-like illness during an influenza pandemic. Available at: http://wwwhpaorguk/web/HPAwebFile/HPAweb_C/1238055329071 (accessed 30 Oct 2009).Google Scholar
93US Department of Health and Human Services. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009–2010 Season. Available at: http://wwwflugov/individualfamily/prevention/medicine/antiviralsrecommendhtml (accessed 2 Nov 2009).Google Scholar
94Novel Swine-Origin Influenza A Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. New Eng J Med 2009; 360: 2605–15.Google Scholar
95World Health Organization. Pandemic Influenza Preparedness and Response: A WHO Guidance Document. Available at: http://wwwwhoint/csr/disease/influenza/PIPGuidance09pdf (accessed 2 Nov 2009).Google Scholar
96Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. Morbid Mortal Weekly Rep 2009; 58: 521–24.Google Scholar
97Peiris, JSM, Poon, LLM, Guan, Y. Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans. J Clin Virol 2009; 45: 169–73.Google Scholar
98Fell, G. Preparedness of residential and nursing homes for pandemic flu. J Public Health 2008; 30: 99102.Google Scholar
99Mody, L, Cinti, S. Pandemic influenza planning in nursing homes: are we prepared? J Am Geriatr Soc 2007; 55: 1431–37.Google Scholar
100US Department of Health and Human Services. Vaccine Priority Groups. Available at: http://wwwflugov/individualfamily/vaccination/vprioritygroupshtml (accessed 30 Oct 2009).Google Scholar