Volume 54, Issue 7 p. 1062-1067

Assessment of Pneumonia in Older Adults: Effect of Functional Status

Lona Mody MD, MSc

Lona Mody MD, MSc

From the Divisions of * Geriatric Medicine Infectious Diseases, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Medical School, University of Michigan, Ann Arbor, Michigan § Department of Sociology, Cleveland State University, Cleveland, Ohio.

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Rongjun Sun PhD

Rongjun Sun PhD

From the Divisions of * Geriatric Medicine Infectious Diseases, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Medical School, University of Michigan, Ann Arbor, Michigan § Department of Sociology, Cleveland State University, Cleveland, Ohio.

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Suzanne F. Bradley MD

Suzanne F. Bradley MD

From the Divisions of * Geriatric Medicine Infectious Diseases, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Medical School, University of Michigan, Ann Arbor, Michigan § Department of Sociology, Cleveland State University, Cleveland, Ohio.

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First published: 06 July 2006
Citations: 52
Address correspondence to Lona Mody, MD, 11G GRECC, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105.
E-mail: [email protected]

Abstract

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment.

DESIGN: Prospective cohort study.

SETTING: University hospital.

PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled.

MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI).

RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS±standard deviation (5.62±0.51 days) than the FD group (11.42±2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24±12.9 vs 4.72±6.55, P<.001).

CONCLUSION: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.