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Cohort study
Increased city-level influenza mortality and state-level influenza severity is associated with greater functional decline among nursing home residents
  1. Susan Hardy
  1. Department of Medicine/Geriatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to: Dr Susan Hardy
    Department of Medicine/Geriatrics, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; seh46{at}

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Implications for practice and research

  • Prevention of exposure to influenza among long-stay nursing home residents has the potential to prevent significant morbidity, including functional decline.

  • Nursing home quality measures may need to be adjusted seasonally or for regional influenza severity.

  • Future research is needed to confirm these associations on an individual level and to determine if preventive measures, such as resident and staff vaccination and hand hygiene, can prevent functional decline and other adverse outcomes.


In the USA, 90% of the estimated 24 000 influenza-related deaths each year occur in older adults,1 and rates (per 100 000 person-years) of hospitalisation for influenza and its complications increase steadily with age, from 111 …

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  • Competing interests None.