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Pneumonia and influenza: specific considerations in care homes

By Adam Gordon and Victoria Ewan


This review provides an update on current evidence surrounding epidemiology, treatment and prevention of lower respiratory tract infection, with special reference to pneumonia and influenza, in care home residents. The care home sector is growing and provides a unique ecological niche for infections, housing frail older people with multiple comorbidities and frequent contact with healthcare services. There are therefore considerations in the epidemiology and management of these conditions which are specific to care homes. Opportunities for prevention, in the form of vaccination strategies and improving oral hygiene, may reduce the burden of these diseases in the future. Work is needed to research these infections specifically in the care home setting and this article highlights current gaps in our knowledge

Publisher: Cambridge University Press
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Provided by: Nottingham ePrints

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  1. (2004). A national census of care home residents. Age and Ageing,
  2. A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia. New England
  3. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia.
  4. Acid-suppressive medication use and the risk for hospital-acquired pneumonia.
  5. Ageing and infection. The Lancet Infectious Diseases. doi
  6. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia.
  7. An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents. New England
  8. Antibiotics and terminal pneumonia. A postmortem microbiological study.
  9. Antibody response to influenza vaccination in the elderly: A quantitative review.
  10. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Annals of Periodontology. doi
  11. Comparison of elderly people's technique in using two dry powder inhalers to deliver zanamivir: randomised controlled.
  12. (2009). Complications: tracking down the data on oseltamivir. BMJ.
  13. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.
  14. Differences in etiology of pneumonias in nursing home and community patients.
  15. Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia.
  16. (2004). Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in
  17. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial.
  18. (1999). Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic.
  19. (1995). Effectiveness of oral antibiotic treatment in nursing home-acquired pneumonia.
  20. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clinical Infectious Diseases.
  21. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. The Lancet.
  22. (1977). Effects of vaccination on an influenza epidemic in a geriatric hospital. Developments in Biological Standardization.
  23. Efficacy of pneumococcal vaccination in adults: A meta-analysis.
  24. Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans. doi
  25. Epidemiology and outcomes of healthcare-associated pneumonia: results from a large US database of culture-positive pneumonia.Chest.
  26. Etiology of severe pneumonia in the very elderly.
  27. Evidence-based guidelines for management of nursing home-acquired pneumonia.
  28. Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households.
  29. (2008). for Disease Control and Prevention. CDC Issues Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses,
  30. (2004). for Disease Control and Prevention. National Nursing Home Survey.
  31. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the working party on hospitalacquired pneumonia of the british society for antimicrobial chemotherapy. doi
  32. (2002). Health Survey for England 2000: Characteristics of Care Homes and Their Residents. London: The Stationary Office;
  33. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Current Opinion in Infectious Diseases.
  34. Increasing influenza immunization for long-term care facility staff using quality improvement.
  35. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clinical Infectious Diseases.
  36. (2000). Infection Control in Long Term Care Facilities. Clinical Infectious Diseases.
  37. (1996). Infections and antibiotic resistance in nursing homes. Clinical Microbiological Reviews.
  38. Influenza A Virus Investigation Team. Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. New England doi
  39. Influenza control in the 21st century: Optimizing protection of older adults.
  40. (2006). Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database of Systematic Reviews.
  41. Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries.
  42. Influenza Vaccination of Healthcare Workers: a Literature Review of Attitudes and Beliefs.
  43. Influenza vaccine and pneumonia mortality in a nursing home population.
  44. Influenza Vaccine Effectiveness among Elderly Nursing Home Residents: A Cohort Study.
  45. Influenza Vaccine Effectiveness in Preventing Hospitalization for Pneumonia in the Elderly.
  46. Influenza-Associated Hospitalizations in the United States.
  47. Influenza-like illness in residential care homes: a study of the incidence, aetiological agents, natural history and health resource utilisation. doi
  48. Inhaled Zanamivir Versus Placebo for the Prevention of Influenza Outbreaks in an Unvaccinated Long-term Care Population.
  49. Interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia. doi
  50. Interventions to prevent aspiration pneumonia in older adults: a systematic review.
  51. Long-Term Use of Oseltamivir for the Prophylaxis of Influenza in a Vaccinated Frail Older Population.
  52. Modifiable risk factors for nursing homeacquired pneumonia. Clinical Infectious Diseases.
  53. Modification of the risk of mortality from pneumonia with oral hygiene care.
  54. (2003). Nosocomial pneumonia. Intensive Care Medicine.
  55. (1997). Nursing Homes in 10 Nations: A Comparison Between Countries and Settings. Age and Ageing.
  56. Nutritional Issues in Nursing Home Care. Annals of Internal Medicine.1995;123(11):850-9.
  57. (2009). of Clinical Excellence. TA158 Influenza (prophylaxis) -amantadine, oseltamivir and zanamivir: guidance. Available at http://guidanceniceorguk/TA158/Guidance/pdf/English (accessed 1st
  58. (2009). of Clinical Excellence. TA168 Influenza - zanamivir, amantadine and oseltamivir (review): guidance. Available at http://http://guidanceniceorguk/TA168/Guidance/pdf/English (accessed 1st
  59. (2009). of Health and Human Services. Vaccine Priority Groups.
  60. Oral care and pneumonia. Oral Care Working Group.
  61. Oral care reduces pneumonia in older patients in nursing homes.
  62. Oral flora of elderly patients following acute medical admission.
  63. Oral health is cost-effective to maintain but costly to ignore.[comment].
  64. (2000). Organization. Influenza vaccines: recommendations for the use of inactivated influenza vaccines and other preventive measures. Weekly Epidemiological Record.
  65. (2009). Organization. Pandemic Influenza Preparedness and Response: A WHO Guidance Document. doi
  66. Oseltamivir Resistance -- Disabling Our Influenza Defenses.
  67. Pandemic Influenza Planning in Nursing Homes: Are We Prepared? doi
  68. (2007). Pandemic Influenza: Guidance for infection control in hospitals and primary care settings. London, Department of Health,
  69. Pathogenic colonization of oral flora in frail elderly patients fed by nasogastric tube or percutaneous enterogastric tube. doi
  70. Pharmacologic prevention of aspiration pneumonia: a systematic review.
  71. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review.
  72. Pneumococcal vaccines: confronting the confounders.
  73. Preparedness of Residential and Nursing Homes for Pandemic Flu. doi
  74. Prescription of anti-influenza drugs for healthy adults: a systematic review and meta-analysis. The Lancet Infectious Diseases.
  75. Prevention of community-acquired pneumonia among a cohort of hospitalized elderly: benefit due to influenza and pneumococcal vaccination not demonstrated.
  76. Profiling disability within nursing homes: a censusbased approach. Age and Ageing.
  77. Prospective surveillance for healthcare-associated infections in German nursing home residents.
  78. (2009). Protection Agency. Pandemic flu: Clinical management of patients with an influenza-like illness during an influenza pandemic doi
  79. (1995). Quantity and avidity of pneumococcal antibodies before and up to five years after pneumococcal vaccination of elderly persons. Clinical Infectious Diseases.
  80. (1999). Respiratory pathogen colonization of the dental plaque of institutionalized elders. Special Care in Dentistry.
  81. Risk factors for nosocomial pneumonia in the elderly.
  82. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.
  83. Saliva secretion and oral flora in prolonged nasogastric tube-fed elderly patients. doi
  84. Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. Morbidity and Mortality Weekly Report.
  85. Service needs of residents in community-based long-term care facilities in northern Taiwan.
  86. (2009). Should healthcare workers have the swine flu vaccine? British Medical Journal.
  87. (1986). Significance of pharyngeal colonization with aerobic gram-negative bacilli in elderly institutionalized men. Age and Ageing.
  88. Summary report: influenza vaccination uptake for healthcare workers (HCWs) in England. Winter season 2008/09 at df.
  89. Surveillance for outbreaks of respiratory tract infections in nursing homes.
  90. Systematic review of the association between respiratory diseases and oral health.
  91. The ethics of mandatory vaccination against influenza for health care workers.
  92. The Lancet.
  93. (2007). Transmission of influenza A in human beings. The Lancet Infectious Diseases.
  94. Treatment strategy and risk of functional decline and mortality after nursing-home acquired lower respiratory tract infection: two prospective studies in residents with dementia.
  95. Underutilization of pneumococcal vaccine in nursing homes in Washington state: Report of a serotype-specific outbreak and a survey.
  96. Unusual outbreak of influenza A in a Wyoming nursing home.
  97. Uptake of influenza vaccination in Dutch nursing home personnel following national recommendations.
  98. (2007). Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews

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