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. 2019 Aug 5;19(1):210.
doi: 10.1186/s12877-019-1236-6.

The burden of respiratory infections among older adults in long-term care: a systematic review

Arielle Childs  1   2 , Andrew R Zullo  3   4   5 , Nina R Joyce  1   2 , Kevin W McConeghy  2   6 , Robertus van Aalst  7   8 , Patience Moyo  2 , Elliott Bosco  2 , Vincent Mor  2   6 , Stefan Gravenstein  2   6
Affiliations

The burden of respiratory infections among older adults in long-term care: a systematic review

Arielle Childs et al. BMC Geriatr. .

Abstract

Background: Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. To address the critical need for evidence regarding the global burden of respiratory infections in LTCFs, we assessed the burden of respiratory infections in LTCFs through a systematic review of the published literature.

Methods: We identified articles published between April 1964 and March 2019 through searches of PubMed (MEDLINE), EMBASE, and the Cochrane Library. Experimental and observational studies published in English that included adults aged ≥60 residing in LTCFs who were unvaccinated (to identify the natural infection burden), and that reported measures of occurrence for influenza, respiratory syncytial virus (RSV), or pneumonia were included. Disagreements about article inclusion were discussed and articles were included based on consensus. Data on study design, population, and findings were extracted from each article. Findings were synthesized qualitatively.

Results: A total of 1451 articles were screened for eligibility, 345 were selected for full-text review, and 26 were included. Study population mean ages ranged from 70.8 to 90.1 years. Three (12%) studies reported influenza estimates, 7 (27%) RSV, and 16 (62%) pneumonia. Eighteen (69%) studies reported incidence estimates, 7 (27%) prevalence estimates, and 1 (4%) both. Seven (27%) studies reported outbreaks. Respiratory infection incidence estimates ranged from 1.1 to 85.2% and prevalence estimates ranging from 1.4 to 55.8%. Influenza incidences ranged from 5.9 to 85.2%. RSV incidence proportions ranged from 1.1 to 13.5%. Pneumonia prevalence proportions ranged from 1.4 to 55.8% while incidence proportions ranged from 4.8 to 41.2%.

Conclusions: The reported incidence and prevalence estimates of respiratory infections among older LTCF residents varied widely between published studies. The wide range of estimates offers little useful guidance for decision-making to decrease respiratory infection burden. Large, well-designed epidemiologic studies are therefore still necessary to credibly quantify the burden of respiratory infections among older adults in LTCFs, which will ultimately help inform future surveillance and intervention efforts.

Keywords: Frail elderly; Nursing homes; Respiratory syncytial virus infections; Respiratory tract infections; Systematic review.

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Conflict of interest statement

All authors declare no competing interests, conflicts of interest, or financial ties to disclose, except R.V.A., who discloses that he is an employee of Sanofi Pasteur.

Figures

Fig. 1
Fig. 1
Flow of the selection process for literature included in the review. Asterisk symbol (*) in Figure indicates that articles could not be evaluated because they were in not written in English; the full text could not be accessed; or measures of occurrence were not presented and there were insufficient data to calculate measures of occurrence for infections of interest
See this image and copyright information in PMC

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