# Association between preexisting long‐term care needs and in‐hospital mortality and long‐term outcomes in older inpatients with pneumonia: A retrospective cohort study

## TL;DR

Older pneumonia patients with higher preexisting care needs have worse short- and long-term outcomes, including higher mortality rates.

## Contribution

This study demonstrates that preexisting long-term care needs independently predict mortality and functional decline in older pneumonia patients.

## Key findings

- Patients with higher care needs had significantly higher in-hospital mortality rates.
- Preexisting care needs were independently associated with death or worsening care needs at 6 months.
- The association remained significant after adjusting for potential confounders.

## Abstract

Limited evidence exists regarding the impact of baseline functional and cognitive impairments on the outcomes of patients with pneumonia.

We used medical and long‐term care administrative databases in a prefecture in Japan that contained care need levels assessed using the national standardized certification system. We identified patients aged ≥65 years who were hospitalized for pneumonia between June 2014 and October 2018. The impairments were classified into four categories based on estimated total daily care time: no care needs, support levels 1–2, care needs level 1 (estimated care time of 25–49 min), care needs level 2–3 (50–89 min), and care needs level 4–5 (≥90 min). The primary outcome was the in‐hospital mortality rate. Secondary outcomes were death and care needs at 6 months and 1 year after admission. We evaluated the outcomes based on care need levels and conducted multivariate analyses adjusting for potential confounders.

A total of 15,537 patients (mean age 83.9 years) were included. The in‐hospital mortality rates for patients with no care needs, support levels 1–2 and care needs level 1, care needs levels 2–3, and care needs levels 4–5 were 10.5%, 15.9%, 21.1%, and 24.7%, respectively. The proportions of patients who died or experienced worsening care needs at 6 months were 43.6%, 60.4%, 60.0%, and 50.2%, respectively. Multivariable analyses demonstrated independent associations of preexisting care needs with both in‐hospital mortality and long‐term outcomes.

Preexisting long‐term care needs are associated with short‐ and long‐term outcomes in older inpatients with pneumonia.