Interventions to prevent pneumonia in older adults

Abstract

Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most common risk factors for pneumonia. Impairments in swallowing and cough reflexes among older adults, for example related to cerebrovascular disease, increase the risk of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. Since both swallowing and cough reflexes are mediated by endogenous substance P, pharmacologic therapy using angiotensin‐converting enzyme inhibitors, which decrease substance P catabolism, may improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine, may affect the incidence of pneumonia. Furthermore, since mortality from infections correlates with cutaneous anergy, interventions that reverse these age‐associated changes in the immune system are also effective.