PDF(Pubmed)
Abstract：
BACKGROUND: Lower Respiratory Tract Infections (LRTI) pose a serious threat to older adults but may be underdiagnosed due to atypical presentations. Here we assess LRTI symptom profiles and syndromic (symptom-based) case ascertainment in older (≥ 65y) as compared to younger adults (< 65y).
METHODS: We included adults (≥ 18y) with confirmed LRTI admitted to two acute care Trusts in Bristol, UK from 1st August 2020- 31st July 2022. Logistic regression was used to assess whether age ≥ 65y reduced the probability of meeting syndromic LRTI case definitions, using patients\' symptoms at admission. We also calculated relative symptom frequencies (log-odds ratios) and evaluated how symptoms were clustered across different age groups.
RESULTS: Of 17,620 clinically confirmed LRTI cases, 8,487 (48.1%) had symptoms meeting the case definition. Compared to those not meeting the definition these cases were younger, had less severe illness and were less likely to have received a SARS-CoV-2 vaccination or to have active SARS-CoV-2 infection. Prevalence of dementia/cognitive impairment and levels of comorbidity were lower in this group. After controlling for sex, dementia and comorbidities, age ≥ 65y significantly reduced the probability of meeting the case definition (aOR = 0.67, 95% CI:0.63-0.71). Cases aged ≥ 65y were less likely to present with fever and LRTI-specific symptoms (e.g., pleurisy, sputum) than younger cases, and those aged ≥ 85y were characterised by lack of cough but frequent confusion and falls.
CONCLUSIONS: LRTI symptom profiles changed considerably with age in this hospitalised cohort. Standard screening protocols may fail to detect older and frailer cases of LRTI based on their symptoms.
METHODS: We included adults (≥ 18y) with confirmed LRTI admitted to two acute care Trusts in Bristol, UK from 1st August 2020- 31st July 2022. Logistic regression was used to assess whether age ≥ 65y reduced the probability of meeting syndromic LRTI case definitions, using patients\' symptoms at admission. We also calculated relative symptom frequencies (log-odds ratios) and evaluated how symptoms were clustered across different age groups.
RESULTS: Of 17,620 clinically confirmed LRTI cases, 8,487 (48.1%) had symptoms meeting the case definition. Compared to those not meeting the definition these cases were younger, had less severe illness and were less likely to have received a SARS-CoV-2 vaccination or to have active SARS-CoV-2 infection. Prevalence of dementia/cognitive impairment and levels of comorbidity were lower in this group. After controlling for sex, dementia and comorbidities, age ≥ 65y significantly reduced the probability of meeting the case definition (aOR = 0.67, 95% CI:0.63-0.71). Cases aged ≥ 65y were less likely to present with fever and LRTI-specific symptoms (e.g., pleurisy, sputum) than younger cases, and those aged ≥ 85y were characterised by lack of cough but frequent confusion and falls.
CONCLUSIONS: LRTI symptom profiles changed considerably with age in this hospitalised cohort. Standard screening protocols may fail to detect older and frailer cases of LRTI based on their symptoms.
摘要：
背景：下呼吸道感染（LRTI）对老年人构成严重威胁，但可能由于非典型表现而未被诊断。在这里，我们评估了与年轻人（<65y）相比，老年人（≥65y）的LRTI症状特征和综合征（基于症状的）病例确定。
方法：我们纳入了布里斯托尔两家急性护理信托基金收治的确诊LRTI的成年人（≥18y），英国从2020年8月1日-2022年7月31日。使用Logistic回归评估年龄≥65岁是否降低了符合综合征LRTI病例定义的概率，使用患者入院时的症状。我们还计算了相对症状频率（对数比值比），并评估了不同年龄段的症状如何聚集。
结果：在17,620例临床证实的LRTI病例中，8,487（48.1％）的症状符合病例定义。与那些不符合定义的人相比，这些案件更年轻，患有严重的疾病，并且不太可能接受SARS-CoV-2疫苗接种或患有活动性SARS-CoV-2感染。该组中痴呆/认知障碍的患病率和合并症的水平较低。在控制性行为后，痴呆症和合并症，年龄≥65岁显著降低了符合病例定义的概率(aOR=0.67,95%CI:0.63-0.71).年龄≥65岁的病例不太可能出现发烧和LRTI特异性症状(例如，胸膜炎,痰液）比年轻病例，年龄≥85岁的人的特征是没有咳嗽，但经常混乱和跌倒。
结论：在该住院队列中，LRTI症状谱随着年龄的增加而发生了显著变化。标准筛查方案可能无法根据症状检测LRTI的较老和较脆弱的病例。
方法：我们纳入了布里斯托尔两家急性护理信托基金收治的确诊LRTI的成年人（≥18y），英国从2020年8月1日-2022年7月31日。使用Logistic回归评估年龄≥65岁是否降低了符合综合征LRTI病例定义的概率，使用患者入院时的症状。我们还计算了相对症状频率（对数比值比），并评估了不同年龄段的症状如何聚集。
结果：在17,620例临床证实的LRTI病例中，8,487（48.1％）的症状符合病例定义。与那些不符合定义的人相比，这些案件更年轻，患有严重的疾病，并且不太可能接受SARS-CoV-2疫苗接种或患有活动性SARS-CoV-2感染。该组中痴呆/认知障碍的患病率和合并症的水平较低。在控制性行为后，痴呆症和合并症，年龄≥65岁显著降低了符合病例定义的概率(aOR=0.67,95%CI:0.63-0.71).年龄≥65岁的病例不太可能出现发烧和LRTI特异性症状(例如，胸膜炎,痰液）比年轻病例，年龄≥85岁的人的特征是没有咳嗽，但经常混乱和跌倒。
结论：在该住院队列中，LRTI症状谱随着年龄的增加而发生了显著变化。标准筛查方案可能无法根据症状检测LRTI的较老和较脆弱的病例。
