Abstract
This review examines the current status of knowledge of sepsis and pneumonia in the elderly population and how the dynamics of the pulmonary challenge affects outcome and consequences. Led by an unprecedented shift in demographics, where a larger proportion of the population will reach an older age, clinical and experimental research shows that aging is associated with certain pulmonary changes, but it is during infectious insult of the lungs, as in the case of pneumonia, that the age-related differences in responsiveness and endurance become obvious and lead to a worse outcome than in the younger population. This review points to the neutrophil, and the endothelium as important players in understanding age-associated changes in responsiveness to infectious challenge of the lung. It also addresses how the immunological set-point influences injury-repair phases, remote organ damage and how intake of drugs may alter the state of responsiveness in the users. Further, it points out the importance of considering age as a factor in inclusion criteria in clinical trials, in vitro/ex vivo experimental designs and overall interpretation of results.
Highlights
Aging and Acute Lung InjuryUnderstanding age-related changes of the lung and their impact on cardiopulmonary responses during infectious insult for maintenance of homeostasis is of critical importance for developing novel therapeutic strategies for the treatment of the older patient
The current life expectancy in the US is 78.8 years [1] and it is estimated that by the year 2030, 20% of the US population will be older than 65 [2]
In later life, susceptibility to lung infections increase, and pneumonia occurs in around 25–44 cases per 1000 of elderly individuals [9], and in those >65 years, pneumonia is the major cause of death from infection [10]
Summary
Understanding age-related changes of the lung and their impact on cardiopulmonary responses during infectious insult for maintenance of homeostasis is of critical importance for developing novel therapeutic strategies for the treatment of the older patient. Acute lung injury (ALI), or acute respiratory distress syndrome (ARDS) as currently defined in humans [11,12], is worldwide a major clinical state affecting approximately 1 in every 1250 individuals annually [13]. Pneumonia has great impact on society and the affected individuals and their families by being a primary cause of morbidity, mortality and socioeconomic cost, resulting in >50,000 deaths in the US alone [26]
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