# Pneumonia Risk in Institutionalized Older Adults With Severe Functional Dependency: An Exploratory Analysis Using Standardized Long‐Term Care Assessment Data

## TL;DR

This study identifies risk factors for pneumonia in elderly nursing home residents using routine care data, showing that male sex, low albumin, poor cognition, and recent weight loss are key predictors.

## Contribution

The study demonstrates that standardized long-term care assessments can identify pneumonia risk in resource-limited settings without comprehensive geriatric evaluations.

## Key findings

- Male sex was associated with a 4.69-fold higher risk of pneumonia.
- Lower serum albumin levels were linked to a 63% reduced risk of pneumonia.
- Recent weight loss of ≥3% over six months increased pneumonia risk by 2.65 times.

## Abstract

To identify risk factors for pneumonia among institutionalized older adults with severe functional dependency, using routinely available clinical information from the standardized “Doctor's Written Opinion” for long‐term care insurance.

This retrospective observational study included 257 institutionalized older adults with severe functional dependency (median age, 88 years; 55 men and 202 women) residing in a Japanese nursing home between January 2014 and May 2020. Risk factors for pneumonia were analyzed using medical records and data from the standardized “Doctor's Written Opinion” for long‐term care insurance.

During a median follow‐up of 2.1 years, 51 residents (19.8%) developed pneumonia, which was associated with lower overall survival (log‐rank test, p = 0.001). Among the 102 residents who died during this period, pneumonia was the most common cause of death (37% of deaths). Multivariate Cox regression analysis revealed male sex (hazard ratio [HR] 4.692, 95% confidence interval [CI] 2.352–9.357), serum albumin level (HR 0.368, 95% CI 0.151–0.898), cognitive ability for daily decision‐making (HR 1.626 per one‐point worsening on a four‐point scale, 95% CI 1.082–2.444), and recent weight loss (≥ 3% over the past 6 months) (HR 2.645, 95% CI 1.195–5.858) as significant risk factors.

Male sex, lower serum albumin level, impaired cognitive ability for daily decision‐making, and recent weight loss were associated with an increased risk of pneumonia. Information routinely available in standardized long‐term care assessments may support the identification of individuals at increased risk of pneumonia in resource‐limited long‐term care settings where comprehensive geriatric assessments are not feasible.

A simple, routinely collected long‐term care assessment identified key predictors of pneumonia—male sex, hypoalbuminemia, impaired cognitive ability for daily decision‐making, and weight loss of ≥ 3% over the past 6 months. Tracking short‐term weight loss provides a practical risk marker for institutionalized older adults with severe functional dependency.