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

Background: Limited evidence exists regarding the impact of baseline functional and cognitive impairments on the outcomes of patients with pneumonia. Methods: 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. Results: 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. Conclusion: Preexisting long-term care needs are associated with short- and long-term outcomes in older inpatients with pneumonia.