Cardiorespiratory Hospitalizations Largely Driven by Long-Term Care Facility Residents

Elliot Bosco, PhD

A recent study conducted in long-term care facilities (LTCFs) showed that older adults remained at high risk for respiratory viruses such as influenza and respiratory syncytial virus (RSV).

Elliot Bosco, PhD, and fellow team members from Brown University conducted the study in order to estimate the rate of infection in LTCFs, the severity of the infections, and the monetary implications of caring for ailing patients post-infection during a 6-year time span.

Qualifications for the study included residents having lived in a LTCF for at least 100 days as well as 6 months of continual enrollment in Medicare Part A. Additionally, there were 3 separate age groups: patients aged 65-74 years, 75-84 years, and ≥85 years.

The team pulled data from Medicare Provider Analysis and Review (MedPAR) of LTCF residents from July 3, 2011 to July 1, 2017. The data was analyzed between January 1 and September 30, 2020.

The respiratory viruses researched were pandemic 2009 influenza A(H1N1), human influenza A(H3N2), influenza B, and RSV. Bosco and colleagues were able to track data from 6 respiratory seasons.

The number of respiratory episodes among residents were often influenced by participant age and the rate at which they came into contact with other residents and caretakers. As previous studies showed, LTCF residents are frequently exposed to other people within the facilities, whether out of necessity or social reasons, and are more likely to be exposed to respiratory viruses.

Additionally, many residents of these facilities had physical aged-related complications such as poor lung capacity, reduced chest wall compliance, decreased cough strength, and impaired immune function. These physiological changes played a large role in the rate and severity of infections among older patients.

Discrepancies were found within the 3 different age groups in the study population, which consisted of 2,909,106 residents in LTCF. 581,423 respiratory episodes occurred for the 65-74 years age group (18.5%), 1,062,587 episodes (33.9%) for the 75-84 years age group, and 1,494,952 episodes (47.6%) for the ≥85 years age group.

A notable increase in episodes occurred in older residents of facilities nationwide, which the study attributes to a variety of factors.

The risk of developing a respiratory infection increased as residents became more dependent on caretakers within the facilities, often attributed to the myriad of physiological changes that occur with aging. Infections among older residents often resulted in long stays in facilities.

While younger residents had less cases and less severe responses to infection, all age groups were predominantly impacted by seasonal influenza and RSV. Additionally, the total of all residents in the study made up half off all influenza-associated hospitalizations in the United States during the 2014-2015, season as well as 64% of all influenza-related deaths.

Approximately $2.6 billion in medical costs in 2015 were attributed to influenza-related treatment. The staggering amount of infected residents, as well as the financial implications placed on the healthcare systems were highlighted in the teams findings.

While no direct conclusion was made, the team did recommend further study into how older patients are treated for influenza-related injuries, how LTCFs impact the rate at which older patients are infected, and the safety measures that can be conducted in order to treat patients while also cutting down on the costs of treatment for both patients and medical facilities.

“Resources should be devoted to prevent the transmission of seasonal influenza and RSV in LTCFs and to reduce the burden on LTCF residents and the health care system.” The team wrote.

The study, “Estimated Cardiorespiratory Hospitalizations Attributable to Influenza and Respiratory Syncytial Virus Among Long-term Care Facility Residents” was published online in Infectious Diseases.