Chiang Jui-Kun, Kao Hsueh-Hsin, Kao Yee-Hsin
Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 622, Taiwan.
Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40201, Taiwan.
Healthcare (Basel). 2024 Feb 8;12(4):443. doi: 10.3390/healthcare12040443.
(1) Background: Pneumonia stands as a prevalent infectious disease globally, contributing significantly to mortality and morbidity rates. In Taiwan, pneumonia ranks as the third leading cause of death, particularly affecting the elderly population (92%). This study aims to investigate factors associated with community-acquired pneumonia (CAP) among elderly individuals receiving home-based care. (2) Methods: Conducted between January 2018 and December 2019, this retrospective study involved a medical chart review of elderly patients under home-based care. A multiple logistic regression model was employed to identify factors associated with CAP in this demographic. (3) Results: Analysis encompassed 220 elderly patients with an average age of 82.0 ± 1.1 years. Eighty-five patients (38.6%) were hospitalized for CAP. Predominant diagnoses included cancer (32.3%), stroke (24.5%), and dementia (23.6%). Significant predictors of CAP for elderly patients under home-based care included male gender (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.95-8.60, < 0.001), presence of a nasogastric (NG) tube (OR = 8.85, 95% CI: 3.64-21.56, < 0.001), and a borderline negative association with the use of proton pump inhibitors (PPIs) (OR = 0.37, 95% CI: 0.13-1.02, = 0.0546). End-of-life care indicators for these patients with CAP included an increased number of hospital admission days in the last month of life (OR = 1.13, 95% CI: 1.08-1.18, < 0.001) and a higher likelihood of hospital death (OR = 3.59, 95% CI: 1.51-8.55, = 0.004). (4) Conclusions: In the current study, significant predictors of CAP among elderly patients receiving home-based care included the presence of an NG tube and male gender, while the use of PPIs was borderline inversely associated with the risk of CAP. Notably, more admission days in the last month of life and death in the hospital were found to be associated with end-of-life care for this group.
(1) 背景：肺炎是全球一种普遍的传染病，对死亡率和发病率有重大影响。在台湾，肺炎是第三大死因，尤其影响老年人群（92%）。本研究旨在调查接受居家照护的老年人中与社区获得性肺炎（CAP）相关的因素。(2) 方法：本回顾性研究于2018年1月至2019年12月进行，涉及对接受居家照护的老年患者的病历审查。采用多元逻辑回归模型来确定该人群中与CAP相关的因素。(3) 结果：分析纳入了220名平均年龄为82.0±1.1岁的老年患者。85名患者（38.6%）因CAP住院。主要诊断包括癌症（32.3%）、中风（24.5%）和痴呆（23.6%）。接受居家照护的老年患者发生CAP的显著预测因素包括男性（比值比[OR]=4.10，95%置信区间[CI]：1.95 - 8.60，<0.001）、存在鼻胃管（NG）（OR = 8.85，95% CI：3.64 - 21.56，<0.001），以及与使用质子泵抑制剂（PPI）存在临界负相关（OR = 0.37，95% CI：0.13 - 1.02，= 0.0546）。这些CAP患者的临终关怀指标包括生命最后一个月住院天数增加（OR = 1.13，95% CI：1.08 - 1.18，<0.001）和医院死亡可能性更高（OR = 3.59，95% CI：1.51 - 8.55，= 0.004）。(4) 结论：在本研究中，接受居家照护的老年患者发生CAP的显著预测因素包括存在鼻胃管和男性，而使用PPI与CAP风险存在临界负相关。值得注意的是，发现生命最后一个月更多的住院天数和在医院死亡与该组患者的临终关怀有关。
