부산대학교 도서관

Although the leading cause of death by infection in the elderly is pneumonia, the risk of death in an elderly patient with pneumonia is quite variable. The primary care physician who treats the elderly must make decisions regarding hospital admission, the level of care required, and treatment. Information regarding expected outcome or prognosis would be helpful in early treatment planning. This can be especially important in a rural setting, where decisions must be made regarding transfer of the patient to a larger, better-equipped facility. This study describes the experience of a rural hospital in caring for elderly patients with pneumonia, and presents a model which predicts mortality for that population. The records of all patients 60 years of age and older (133) with a primary diagnosis of pneumonia were reviewed retrospectively. During hospitalization 15.8 percent of the patients (21) died. It was determined that those pneumonia patients with pre-existing conditions of coronary heart disease, dementia, urinary incontinence and impaired mobility were more likely to die. Five characteristics found on initial physical examination and laboratory testing were associated with increased risk of death: impaired mental status, absence of fever, rapid breathing, cyanosis and markedly elevated white blood cell count. Tachypnea, or rapid breathing, may be an early indicator of pneumonia in this population, and severe tachypnea may be a predictor of mortality. Based on these factors a mortality risk scoring system was developed. In addition, it was found that 93 percent of the surviving patients who had been admitted from home returned to their homes, indicating that the elderly patient with pneumonia is not likely to suffer functional impairment as occurs in the case the elderly who suffer stroke or hip fracture. (Consumer Summary produced by Reliance Medical Information, Inc.)
To identify predictors of mortality, the records of 133 elderly patients with pneumonia admitted to a small rural midwestern hospital were examined using a retrospective cohort design. AH recorded clinical information available to the patient's physician within the first hours of admission was reviewed Twenty-one (15.8%) patients died during the hospitalization. Patients with preexisting coronary heart disease, dementia, urinary incontinence, and impaired mobility were more likely to die. Impaired mental status, absence of fever, rapid respiratory rate, hypotension, cyanosis, and diffuse abnormalities on chest examination were also associated with mortality. Logistic regression analysis revealed five predictive indicators of mortality: impaired level of consciousness (odds ratio [OR] = 11.3), tachypnea (OR = 10.8), temperature lower than normal (OR = 14.2), white cell count higher than 20 x 10[.sup.9]/L (20,000 mm[.sup.-3]) (OR = 12.2), and cyanosis (OR = 8.6). A risk score based on this regression model demonstrated that 1 of 95 patients with a score lower than 3 (1%), 7 of 22 with a score of 3 (32%), and 13 of 15 patients with a score higher than 3 (87%.) died during their hospitalization. The validity of this risk-scoring system was confirmed in another sample of 40 patients. Studies such as this may be useful in identifying information of important prognostic value that enables physicians, patients, and family members to make more effective decisions. J FAM PRACT 1990; 30:153-159.
In the elderly, pneumonia constitutes the leading infectious cause of death and the fourth leading cause of death overall. (1) Consequently, this important clinical problem is commonly addressed by primary [...]