Health status and assessed need for a cohort of older people admitted to nursing and residential homes

OBJECTIVE: to investigate dependency and health status of a cohort of older people admitted for long term nursing or residential care and to compare these findings with assessments conducted by social services departments prior to placement. DESIGN: retrospective cohort study. SETTING: residential, nursing and dual registered homes within Nottingham Health Authority boundaries. SUBJECTS: 205 residents placed over 3 months. MAIN OUTCOME MEASURES: levels of disability, cognitive impairment and behavioural disturbance identified by assessment before and after admission. RESULTS: cognitive impairment and physical disability were significantly higher in nursing homes, although a third of residents in residential care had substantial physical disability. In nursing homes, a quarter of residents had low dependency needs but these had greater cognitive impairment than those in residential homes with the same level of dependency. Most residents had some degree of behavioural disturbance (particularly in nursing homes) and more severe disturbance was associated with greater cognitive impairment and more depressed mood, but not physical disability. A moderate level of agreement was found between preadmission and follow-up assessments of health status. CONCLUSIONS: a case-mix which includes higher dependency residents in residential homes and lower dependency residents in nursing homes is likely to reflect changes in the health status of residents following placement but also suggests that a range of placement criteria were used together, rather than individual indicators of need. Although pre-placement measures of disability and dependency were supported by follow-up assessments, it is essential that the needs of residents in long-term care are adequately monitored and managed, in particular those in residential care with higher dependency needs.     

Functional disability of older persons in long-term care facilities in Korea

The aim of this study was to examine functional disability of older persons in long-term care facilities and to identify factors associated with their levels of functioning. The first national survey of older residents in nursing and residential care homes in Korea was conducted in 1999. Of the 1105 respondents who completed the interview 73% in residential care homes and 88% in nursing homes reported limitations in functioning. The percentage of persons with three or more limitations in activities of daily living (ADL) was 63% among nursing home residents and 36% among those at residential care homes. Overall, persons of older age, female, widowed, with less family support, and bearing out-of-pocket costs of medical care tended to show higher levels of disability. Presence of arthritis, hypertension, and stroke was found to be significantly associated with increased likelihood of disability. Multivariate analysis revealed variability in the associations by type of facility. Characteristics such as older age, women, and stroke were significantly associated with a higher likelihood of disability for those in both residential and nursing homes. Arthritis, fracture, exercise, and contact with family members, however, were found to be independently associated with disability among those in residential care homes only. Recent government proposals to improve care delivered to long-term care residents need to take into account their differing levels of functional disability and its associated care needs.     

Demographics and payment characteristics of nursing home residents in the United States: a 23-year trend

BACKGROUND: With the aging of our population, an increased number of older Americans are expected to reside in nursing homes. Our objective is to determine the national trend in nursing home residence for older Americans. METHODS: Using the Beyond 20/20 software, we analyzed publicly available data from National Nursing Home Surveys 1977-1999 to determine the trend in the demographics, marital status, and source of payments for older Americans residing in nursing homes. RESULTS: The absolute number of persons aged 65 years and older residing in nursing homes increased from 1,126,000 to 1,469,500 during the 23-year study period, with those aged 85 years and older, women, and African Americans being at a higher risk for nursing home placement. The rate of residence per 1000 civilian population actually declined from 58 to 43. Decline was most notable for persons aged 85 years and older, female, and white residents. The proportion of widowed persons among residents declined during the study period as well. Overall, Medicaid and private sources were the most common sources of payment. In 1999, Medicaid use was particularly prevalent among residents who were aged 65-74 years old, women, and/or African Americans. CONCLUSIONS: Older Americans at high risk for placement in nursing home facilities are aged 85 years and older, women, and African Americans, who are also more likely to rely on Medicaid as their primary source of payment. Preventive programs to keep older adults in the community should focus on this group of high-risk older adults.     

Hip fracture incidence in nursing home residents and community-dwelling older people,Washington State, 1993-1995

OBJECTIVES: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non-nursing home residents. DESIGN: Retrospective analysis of Medicare population-based enrollment, hospital claims, and nursing home administrative data sets. SETTING: Nursing home and non-nursing home setting. PARTICIPANTS: Medicare beneficiaries in Washington State residing in the community or in skilled nursing facilities. MEASUREMENTS: Crude age- and sex-specific and standardized age- and sex-adjusted hip fracture incidence for persons residing and not residing in nursing homes. RESULTS: From October 1, 1993, through September 30, 1995, 7,812 Medicare beneficiaries aged 65 or older were hospitalized for hip fractures (6,566 fractures for 1,155,234 person-years of exposure in non-nursing home residents and 1,246 fractures for 42,986 person-years of exposure in nursing home residents). The standardized age- and sex-adjusted hip fracture rate of nursing home residents (23.0 per 1,000 person-years) substantially exceeded that of non-nursing home residents (5.7 per 1,000 person-years) (incidence rate ratio = 4.0, 95% confidence interval = 3.7-4.5). CONCLUSION: The incidence of hip fracture in nursing home residents far exceeds that in noninstitutionalized older people. Linkage of MDS and Medicare hospital claims data is a useful tool for epidemiological surveillance regarding events in nursing homes that are likely to result in hospitalization.     

Projected use of long-term-care services by enrolled Veterans

PURPOSE: The purpose of this article is to describe the projected use for long-term-care services through 2012. DESIGN AND METHODS: We constructed a static-component projection model using age, function, and other covariates. We obtained enrollee projections from the Veterans Health Administration (VHA) and combined these with nursing home and community long-term-care service use rates from the 1999 National Long-Term Care Survey and the 2000 National Health Interview Survey. RESULTS: Over the next decade, the number of oldest veterans (aged 85+) will double, and VHA-enrolled veterans aged 85 and older will increase sevenfold. This will result in a 20-25% increase in use for both nursing home and home- and community-based services. VHA currently concentrates 90% of its long-term-care resources on nursing home care. However, among those who receive long-term care from all formal sources, 56% receive care in the community. Age and marital status are significant predictors of use of either type of formal long-term-care service for any given level of disability. VHA's experience with the mandatory nursing home benefit suggests that even when the cost to the veteran is near zero, only 60-65% of eligibles will choose VHA-provided care. Assisted living represents nearly 15% of care provided during the past decade to individuals in nursing homes, and approximately 19% of veterans using nursing homes have disability levels comparable to those of men supported in assisted living. IMPLICATIONS: As most of the increased projected use for long-term care will be for home- and community-based services, VHA will need to expand those resources. Use of VHA resources to leverage community services may offer new opportunities to enhance community-based long-term care.     

The right person? the right place? the right time? a pilot study of the appropriateness of nursing home placements

The appropriate use of health services is a key challenge for the NHS. Older people have been consistently identified as being disproportionately represented amongst those defined as 'inappropriately' located within the acute health sector. Prior to the introduction of community care it was hypothesised that older people were entering nursing home care inappropriately. With the requirement for assessment prior to entry into nursing homes now a feature of the system such 'inappropriate' admissions should not occur. This pilot study investigates the feasibility of determining inappropriate admissions and the extent of this phenomenon in nursing homes used by three inner London Boroughs. To determine the number of 'inappropriate' placements in nursing homes in three London Boroughs (Lambeth, Southwark & Lewisham). Retrospective audit of nursing home case notes using standardised data collection method. New local authority funded admissions to nursing homes from LSL during the period 1 April 1993-31 March 1995. One hundred and fifty seven people entered the 25 nursing homes identified. For 65% nursing home placement was appropriate, 14% were apparently more suited to residential care and 17% for community care. Documentation concerning clients held by the nursing homes was generally poor. Despite the introduction of the Community Care Act and the clear requirement for assessment before entry into nursing home care, approximately one-third of the placements reviewed were inappropriate and did not meet the individual's care needs. Further research is underway to determine if these findings apply nationally.     

Psychiatric disease and social isolation in elderly nursing home residents: a comparative study

As part of a population-based morbidity survey, a sample of over-65-year-old residents of geriatric nursing homes and old people's homes (N = 153) in the city of Mannheim, F.R.G. (Popn. 308,000) was investigated with regard to mental and physical impairment, as well as to the frequency and quality of their family and social contacts. Corresponding data from the investigation of a community sample (N = 350) served as a basis for a direct comparison of old people in residential care and those living in the community. The findings point to a large relative excess both of mental impairments--especially organic brain syndromes--and of physical disabilities among the nursing-home residents. Those in old people's homes, in marked contrast, do not differ in these respects from persons of the same age living in the community. The home residents have on average far fewer social contacts, and derive less help and support from their social relationships, than do their contemporaries who live in private households. From this point of view, there appears to be little difference between those in nursing homes and those in old people's homes. The observed disparities between the home and community samples remained significant following statistical correction of the data for differences in the sample distributions by age and by marital status. The implications of these findings for further research and for geriatric service-planning are discussed.     

Dependency in older people recently admitted to care homes

OBJECTIVE: to investigate dependency and general health status of a cohort of older people admitted to residential or nursing homes for long-term care. METHOD: we assessed 308 people aged over 65 years within 2 weeks of admission for long-term care to one of 30 nursing or residential homes in north-west England. Dependency was assessed using the Barthel activities of daily living index and the Crichton Royal Behaviour Rating Scale. We collected information from the homes' records on diagnosed conditions and current medication. RESULTS: 50% of the cohort were in a 'low dependency' band (Barthel score 13 - 20): 31% of those in nursing homes and 71% of those in residential homes. In nursing homes, low-dependency residents were more likely to be self-funding than those with higher dependency. Of a number of broad diagnostic groupings, only a diagnosis of dementia was associated with nursing- rather than residential-home admission. Of 47 residents who scored 9 or less on the Mini-Mental State Examination (indicating severe cognitive impairment), 85% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. DISCUSSION: the high proportion of new admissions of subjects with low dependency needs raises questions about the effective targeting of resources and about management of the boundary between home-based and institutional care. The existence of an important group of self-funded, low-dependency new admissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local authorities. Many new admissions had conditions which might benefit from rehabilitation but there were almost no therapy staff in the studied homes. In some cases where severe cognitive impairment was evident, there was no evidence that the result of any formal pre-admission psychiatric evaluation had been communicated to nursing or care staff.     

Assessing life expectancies of institutionalized older persons in Hong Kong

BACKGROUND: In Hong Kong, it has been projected that, by the year 2010, there will be 0.86 million persons aged 65 or older. The demand for residential care places continues to rise. Information on the survival of older persons will allow better management of care in institutional settings. OBJECTIVE: The Weibull model was developed to predict the 18-month survival of a group of Chinese nursing home residents. METHODS: In this prospective cohort study, 590 older residents from four nursing homes with different levels of care were enrolled. The main outcome measure was survival at 18 months. Information on subject demographics, clinical data and disability levels as measured by the Patient Assessment Instrument (PAI) was collected at baseline. Life expectancies were derived from accelerated failure time models. RESULTS: Independent predictors of decreased survival derived from the Weibull model included increased age, male gender, diagnosis of cancer, presence of malnutrition and functional dependence. Significant interaction was observed between male gender and PAI score. The goodness of fit of the model was satisfactory. CONCLUSIONS: From this study, the model for predicting life expectancy in nursing home residents can assist policy makers in planning long-term care. It can also guide clinicians to make more appropriate management decisions for their older patients.     

Prevalence of dementia in institutional care

Information about dementia prevalence in residential and nursing care homes helps these institutions to meet residents' needs. We combined residential characteristics ascertained at a screening interview in 1991-93 with dementia diagnoses from assessment interviews in the UK Medical Research Council Cognitive Function and Ageing Study, a population-based study of 13004 elderly people. Almost 5% of people aged 65 years or older lived in institutions--34% (95% CI 30-39) of individuals with dementia. Within institutions, dementia prevalence was 62% (52-71), and was slightly higher in women than in men, with no increase by age. That most residents have dementia has implications for the type of care that institutions provide.     

Does hospice have a role in nursing home care at the end of life?

OBJECTIVES: To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long-term care facilities with those living in the community. DESIGN: Retrospective review of computerized clinical care records. SETTING: A metropolitan nonprofit hospice. PARTICIPANTS: The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community. MEASUREMENTS: Patient characteristics, needs for palliative care, and survival. RESULTS: At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P < .001) and a durable power of attorney for health care (22% vs 10%; P < .001) than were those living in the community. Nursing home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P < .032). Several needs for palliative care were less common among nursing home residents, including constipation (1% vs 5%; P = .02), pain (25% vs 41%; P < .001), and anticipatory grief (1% vs 9%; P < .001). Overall, nursing home residents had fewer needs for care (median 0, range 0-3 vs median 1, range 0-5; rank sum test P < .001). Nursing home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P < .001) and were less likely to withdraw from hospice voluntarily (8% vs 14%; P = .03). However, there was no difference in the likelihood of becoming ineligible during hospice enrollment (6% for both groups). CONCLUSIONS: These results suggest that hospices identify needs for palliative care in a substantial proportion of nursing home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community-dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral.     

Caring too much? Lack of public services to older people reduces attendance at work among their children

The need to provide care for older people can put a strain on their adult children, potentially interfering with their work attendance. We tested the hypothesis that public care for older people (nursing homes or home care services) would moderate the association between having an older parent in need of care and reduced work attendance among the adult children. The analysis used data from a survey of Norwegian employees aged 45–65 (N = 529). Institutional care for older people in need of care (i.e. nursing homes) was associated with improved work attendance among their children—their daughters in particular. Data also indicated a moderating effect: the link between the parents’ reduced health and reduced work attendance among the children was weaker if the parent lived in a nursing home. However, the results were very different for home-based care: data indicated no positive effects on adult children’s work attendance when parents received non-institutionalised care of this kind. Overall, the results suggest that extending public care service to older people can improve their children’s ability to combine work with care for parents. However, this effect seems to require the high level of care commonly provided by nursing homes. Thus, the current trend towards de-institutionalising care in Europe (and Norway in particular) might hamper work attendance among care-giving adult children, women in particular. Home care services to older people probably need to be extended if they are intended as a real alternative to institutional care.     

Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life

OBJECTIVES: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes. DESIGN: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002. SETTING: Minnesota and Texas nursing homes. PARTICIPANTS: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01. MEASUREMENTS: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission. RESULTS: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization. CONCLUSION: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.     

An inpatient bed for acute nursing home admissions

BACKGROUND: Some older patients are admitted directly to nursing homes without a comprehensive assessment. OBJECTIVE: To determine whether a hospital assessment bed might provide better assessment, treatment and a more appropriate placement for selected older people. Setting a single bed in an elderly care unit of a district general hospital. SUBJECTS: Older people who general practitioners thought needed nursing home care but whose social workers felt might benefit from inpatient assessment. MAIN OUTCOME MEASURES: Type of treatment needed (acute care, rehabilitation, palliation, long-term care) and placement (home, nursing home, residential home or hospital). RESULTS: of 34 patients assessed, 22 (65%) needed further clinical assessment or care and 26 (75%) left hospital for places other than nursing homes. CONCLUSIONS: Inpatient assessment is a successful way of assessing the needs of some older people who would otherwise have been admitted directly from their homes to nursing homes.     

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999

Objectives: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. Design: Cross‐sectional national sample surveys of nursing homes and nursing home residents with a two‐stage probability design, stratified on size and Medicare and Medicaid certification status. Setting: U.S. nursing homes during 1995, 1997, and 1999. Participants: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). Measurements: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: “Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?” Vaccination status was coded as yes, no, and unknown. Results: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. Conclusion: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.     

A qualitative interview study comparing and contrasting resident and staff perspectives of engaging in meaningful activity in a UK care home

The provision of meaningful activities in care homes is essential for maintaining residents' mental and physical health, yet many do not get adequate opportunities to participate. This qualitative study explored resident and staff perceptions of engaging in meaningful activities in a residential care home for older people (aged over 65 years) in South London, UK. Nine residents and eleven staff members were recruited and their experiences explored through semi-structured interviews. Data were analysed thematically, and three themes emerged. (1) Appreciation of activity: both staff and residents were aware of the benefits of activity to physical and mental health, yet there was a lack of provision within the home. (2) Residents' desire for engagement: residents perceived themselves as active individuals who had previously enjoyed activities, and had goals that they wanted to achieve. This was in contrast to views of care staff, who perceived residents as inactive, lacking in motivation and sedentary due to intrinsic factors such as their age. (3) Impact of care home culture and physical space: staff and residents perceived different barriers to activity; staff reported they were often expected to take on multiple roles within the home leading to a lack of time to engage residents in activities, whilst residents perceived that the layout and design of the home hindered provision. It was concluded that comparing and contrasting views of residents and staff could assist residential homes to reach greater levels of shared understanding of activity provision and highlight particular areas to target for increasing activity engagement.     

Accelerated dysfunction among the very oldest-old in nursing homes

BACKGROUND: The population aged 65 and older is often analyzed in three categories: young-old (65-74), middle-old (75-84), and oldest-old (> or = 85). This may blind heterogeneity within the oldest category. New, large data sets allow examination of the very oldest-old (e.g., aged > or = 95) and contrasts with those who are younger. METHODS: We determined the annual change of prevalence of physical and cognitive function, and of disease problems in the old to very oldest-old, using data from existing Resident Assessment Instrument records from nursing homes in seven states during 1992-1994. We used data from 193,467 unique residents aged 80 or older, including 6,556 residents aged 100 or older. We computed the prevalence, by age, of selected conditions: physical and cognitive function, diseases, problem behavior, mood disturbance, restraint use, falls, weight loss, eating less, body mass index, chewing and swallowing problems, incontinence (bowel and bladder), catheter use, and selected diagnoses. RESULTS: Prevalence of all measures of physical and cognitive dysfunction increased most rapidly with each year of age among the very oldest-old. Most of the slope changes occurred from 95 to 100 years of age. Such changes are less pronounced or not seen in measures of disease prevalence. CONCLUSIONS: Accelerated change in prevalence of dysfunction seen in the nursing home population may suggest a change in the mechanisms of aging that occur after the mid-nineties. Examination of the very oldest-old may provide new insight into the nature of the aging process.     

Length of stay in VA nursing homes. Comparative characteristics of brief-, medium-, and long-stay residents

To examine the patterns and determinants of length of stay among residents of nursing homes of the Department of Veterans Affairs (VA), the authors conducted a retrospective follow-up study of all persons (n = 4,918) admitted to VA nursing homes between October 1986, and April 1987, using computerized records of the VA. Brief-stay (< 1 month; n = 1,139) residents had most often had previous admissions to VA nursing homes and were usually discharged alive from the nursing home. Medium-stay (1-6 months; n = 1,947) residents were the least functionally impaired and most likely to receive rehabilitative services. Long-stay residents (> 6 months; n = 1,832) were older and more functionally impaired than other residents. Medium- and long-stay residents of VA nursing homes most resembled "short-" and "long-stay" residents among non-VA nursing home residents, respectively. Brief-stay residents may be persons admitted for "respite" services or may be serial users of both VA and non-VA health services. Further study of this population may identify opportunities to decrease "revolving-door" use of nursing home services.     

Trends in disability and disability-free life expectancy among elderly people in Spain: 1986-1999

BACKGROUND: This paper examines recent trends in the prevalence of disability and disability-free life expectancy in the population aged 65 years and older in Spain. METHODS: Data were drawn from two National Disability, Impairment and Handicap Surveys conducted in 1986 and 1999. Only severe disability was studied, and disabilities overcome through use of external technical aids were included. RESULTS: In the period 1986--1999, a relative annual decline of 3.7% in overall disability was observed for men. The decline was somewhat less marked in women, participants aged 75 years and older, and those with the lowest educational level. In men, there was a relative annual decline of just over 3% in walking and hearing disabilities, of under 1% in seeing and cognitive disabilities, and a slight rise in self-care disability. Trends among women were similar, though self-care disability rose by 1.78%. In the period 1986--1999, total and disability-free life expectancy rose across all age groups in both sexes. Among men aged 65 years, the proportion of life expectancy with disability fell from 42.1% in 1986 to 21.6% in 1999; the comparable figures for women were 49.8% in 1986 and 30.6% in 1999. Indeed, a reduction in life expectancy with disability was observed even among persons aged 80 years and older. CONCLUSION: From 1986 through 1999, prevalence of severe disability among Spanish elderly persons decreased substantially, and the duration of life with disability was compressed between a later onset and the time of death. Among women, however, self-care disability--the type of disability requiring most social resources for its attention--underwent a sharp rise.     

Hospitalizations and deaths due to respiratory illnesses during influenza seasons: a comparison of community residents,senior housing residents,and nursing home residents

BACKGROUND: Although research indicates that influenza is a major cause of morbidity and mortality among older adults, few studies have tried to identify which seniors are particularly at risk of experiencing complications of influenza. The purpose of this study was to compare hospitalizations and deaths due to respiratory illnesses during influenza seasons among seniors (aged 65+) living in the community, senior residences (apartments reserved for seniors), and nursing homes. METHODS: Using administrative data, all hospital admissions and deaths due to respiratory illnesses (pneumonia and influenza, chronic lung disease, and acute respiratory diseases) were identified for all individuals aged 65 and older living in Winnipeg, Canada (approximately 88,000 individuals) during four influenza seasons (1995-1996 to 1998-1999). RESULTS: Hospitalization and death rates for respiratory illnesses increased significantly during influenza seasons, compared to fall periods (e.g., 42.7 vs 25.2 hospitalizations per 1000 population aged 80 and older). Moreover, hospitalization rates for pneumonia and influenza, chronic lung disease, and acute respiratory diseases were higher among individuals living in senior residences (42.5 per 1000 for all respiratory illnesses combined) than their counterparts living in the community (22.8 per 1000). Furthermore, deaths due to pneumonia and influenza and chronic lung disease were higher among senior housing residents (4.2 per 1000) than community residents (2.6 per 1000) and were particularly high among nursing home residents (52.1 per 1000). CONCLUSIONS: Individuals living in seniors residences are at increased risk of being hospitalized for and dying of respiratory illnesses during influenza seasons. Given that influenza vaccination is currently the best method to reduce influenza-associated illnesses among seniors, this suggests that influenza vaccination strategies should be targeted at this population.