Community-acquired Pneumonia In Older Adults Research Articles

Association of the NLR, BNP, PCT, CRP, and D-D with the Severity of Community-Acquired Pneumonia in Older Adults

Association of the NLR, BNP, PCT, CRP, and D-D with the Severity of Community-Acquired Pneumonia in Older Adults

Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults

The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1,158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO2 ≤ 90% or PaO2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP.

Clinical and laboratory findings in elderly with Community-Acquired Pneumonia in Babol, northern Iran – 2017-2019

Abstract Morbidity and mortality are higher in older adults with community-acquired pneumonia (CAP) than in other age groups. Also, CAP in older adults has various clinical manifestations with other. A higher mortality rate in the elderly with CAP may contribute to a delay in management. Consequently, the purpose of this study was to investigate the clinical and laboratory manifestations of CAP in the elderly. This cross-sectional study was conducted on 221 elderly patients with CAP who were admitted to Ayatollah Rouhani Hospital, in Babol, northern of Iran, in 2017-2019. Patient outcomes included 170 cases that recovered from CAP, and 51 cases that died of complications. Patients were evaluated in terms of their clinical and laboratory manifestations. The most common symptoms of pneumonia were cough (79.6%), sputum (73.8%), weakness (72.9%), fever (56%), dyspnea (46.2%). The most frequent underlying disease was ischemic heart disease (43.9%). In our study, clinical and laboratory characteristics in older patients with CAP were evaluated and compared with other studies confirming past findings, but there were differences in some cases, such as vital signs, gastrointestinal symptoms, and disturbance of the level of consciousness. Therefore, it recommends carefully taking the patients’ initial histories and accurately recording their clinical and laboratory symptoms.

Older Adults Hospitalized for Pneumonia in the United States: Incidence, Epidemiology, and Outcomes.

To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. The study took place in all nine acute care hospitals for adults in Louisville, KY. Residents in the city of Louisville, KY, who were diagnosed with CAP between the inclusion dates were included and who were aged 65 years or older. Incidence of CAP and outcomes were measured. A total of nine risk factors were also assessed for any potential association with time to clinical stability, length of stay (LOS), and mortality. During the 2-year study, from a Louisville population of 102 264 adults aged 65 years or older, 4760 were hospitalized with CAP. The incidence of older adults hospitalized with CAP was 2093 per 100 000 population. This corresponds to 967 470 older adults in the United States hospitalized per year with CAP. The median time to clinical stability was 2 days, and the median LOS was 6 days. The 30-day all-cause mortality was 17%. The 1-year all-cause mortality was 38% (829 patients), which corresponds to 361 982 deaths in the United States with CAP in older adults. The estimated burden of CAP in older adults is substantial in the United States. Nearly 1 million older adults are hospitalized for CAP, and over a third of those die within 1 year. J Am Geriatr Soc 68:1007-1014, 2020.

Risk of community-acquired pneumonia in older adults with sarcopenia of a hospital from Callao, Peru 2010–2015

IntroductionSarcopenia is a geriatric syndrome characterized by loss of muscle mass and strength. The prevalence in people between 60–70 years is about 5–13% and in adults over 80 years, between 11–50% in the USA. Sarcopenia increases the risk of mortality and nosocomial infections.Community-acquired pneumonia is the first infectious-related cause of death in elderly people. However, there is lack of evidence about the association between sarcopenia and pneumonia. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. MethodsA retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria. MultivariatePoisson regression model was conducted to estimate the effect of the independent association between sarcopenia and pneumonia. ResultsA total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3–16.8) and the incidence of community-acquired pneumonia was 15.14% (95%CI 13.4–16.9). In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82–5.33). DiscussionOur study showed a higher incidence of community-acquired pneumonia in sarcopenic subject. Results provide information on the importance of detecting this syndrome because it gives us scientific evidence of the interest of a correct comprehensive geriatric assessment in older patients with a high risk of pneumonia.

Analysis on risk factors for severe community acquired pneumonia in the elderly

Objective To evaluate the risk clinic factors of severe community-acquired pneumonia in older adults, and to provide examples for its clinic application. Methods Sixty-four case patients who were admitted for a diagnosis of severe community-acquired pneumonia in older adults in Beijing Haidian Hospital from January 2013 to July 2015 were selected as observation group.One hundred cases patients also admitted for a diagnosis of community-acquired pneumonia were selected as control group.Within 24 h of admission, the clinical data were collected, medical history were collected, and the serum biochemistry, coagulation index fibrin degradation product, D-dimer and inflammatory factor procalcitonin were detected.The data were analyzed by univariate analysis, and logistic regression analysis was used to analyze the variables with significant difference in single factor analysis. Results Single factor analysis showed that the percentage of severe pneumonia with central nervous system disorders, severe pneumonia with aspiration, severe pneumonia with two or more comorbidities, aspiration and severe pneumonia with bedridden patient in observation group were obviously higher than the control group, the difference between two groups have remarkable statistical significance((82.21%(53/64) vs.32%(32/100), 60.93%(39/64) vs.1%(1/100), (84.37%, 54/64) vs.54%(54/100), 90.62%(58/64) vs.28%(28/100), 59.37%(38/64) vs.11%(11/100); P<0.01 or P<0.05). The mortality of observation group was higher than the control group, the difference between two groups have remarkable statistical significance(56.62%(36/64)] vs.3%(3/100), P=0.001). Albumin of severe pneumonia was obviously lower than the control group, the difference between two groups have remarkable statistical significance((27.79±8.53) g/L vs.(33.66±9.63) g/L, P=0.011). Fibrin degradation product of severe pneumonia was obviously lower than the control group, the difference between two groups have remarkable statistical significance((10.98±1.32) ng/L vs.(3.61±0.98) ng/L, P=0.002). D- dimer of severe pneumonia was obviously higher than the control group, the difference between two groups have remarkable statistical significance((2.68±0.56) mg/L vs.(0.42±0.12) mg/L, P=0.001). Procalcitonin of severe pneumonia was obviously higher than the control group, the difference between two groups have remarkable statistical significance ((1.63±0.32) ng/L vs.(0.13±0.21) ng/L, P=0.015). The result of multiple factors logistic regression analysis showed the aspiration, hypoproteinemia, D-dimer were severe community-acquired pneumonia in older adults's independent risks(OR=1.782, 1.208, 1.356, P<0.05). Conclusion Aspiration, hypoproteinemia, D-dimer are the factors of risking suffering severe community-acquired pneumonia in older adults.D-dimer could be the detection index of severe community-acquired pneumonia in older adults. Key words: Community-acquired pneumonia; Older; D-dimer; Aspiration

Prospective, Population-Based Surveillance of the Burden of Streptococcus Pneumoniae in Community-Acquired Pneumonia in Older Adults, Chrzanów County, Poland, 2010 to 2012

Introduction: Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is a substantial cause of morbidity and mortality among older adults. This study estimated incidences of CAP, chest X-ray−confirmed CAP (CXR+CAP), S pneumoniae- positive CAP, S pneumoniae-positive CXR+CAP, and S. pneumoniae serotype distribution among 46,000 at-risk adults aged ≥ 50 years residing in Chrzanów County, Poland. Material and methods: From January 2010 to January 2012, all facilities providing ambulatory and inpatient care enrolled all consenting resident patients with suspicion of CAP. Chest X-rays, urine, blood, and sputum samples were analyzed. Annualized incidence rates were determined. Presence of S pneumoniae-positive CAP and/or S. pneumoniae serotype distribution was determined using the urine antigen detection assay (capable of detecting the serotypes in the 13-valent pneumococcal conjugate vaccine [PCV13]), BinaxNOW®, and/or microbiology cultures. Results: Among 5055 enrolled patients, 1195 (23.7%) were diagnosed with CAP and 1166 (23.4%) had CXR+CAP. S. pneumoniae was detected in 144 (12.1%) and 131 (11.2%) patients from the CAP and CXR+CAP cohorts, respectively. Annualized incidence rates of CAP, CXR+CAP, S pneumoniae-positive CAP, and S. pneumoniae-positive CXR+CAP were 12.8, 12.5, 1.6, and 1.4 per 1000 residents, respectively. Among CXR+CAP patients, 39.7% were aged 50 to 64 years and 60.3% were aged ≥ 65 years. Incidence rates generally increased with age. The most common serotypes in S. pneumoniae-positive CXR+CAP patients were 3 (n = 15), 23F (n = 10), 18C (n = 9), and 9V (n = 6). Conclusions: CAP due to PCV13 serotypes is a source of morbidity among adults &gt; 50 years and may be reduced by greater access to pneumococcal vaccines.

Prospective, population-based surveillance of the burden of Streptococcus pneumoniae in community-acquired pneumonia in older adults, Chrzanów County, Poland, 2010 to 2012.

Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is a substantial cause of morbidity and mortality among older adults. This study estimated incidences of CAP, chest x-ray-confirmed CAP (CXR+CAP), S pneumonia- positive CAP, S pneumonia-positive CXR+CAP, and S. pneumoniae serotype distribution among 46,000 at-risk adults aged ≥ 50 years residing in Chrzanów County, Poland. From January 2010 to January 2012, all facilities providing ambulatory and inpatient care enrolled all consenting resident patients with suspicion of CAP. Chest x-rays, urine, blood, and sputum samples were analyzed. Annualized incidence rates were determined. Presence of S pneumonia-positive CAP and/or S. pneumoniae serotype distribution was determined using the urine antigen detection assay (capable of detecting the serotypes in the 13-valent pneumococcal conjugate vaccine [PCV13]), BinaxNOW®, and/or microbiology cultures. Among 5055 enrolled patients, 1195 (23.7%) were diagnosed with CAP and 1166 (23.4%) had CXR+CAP. S. pneumoniae was detected in 144 (12.1%) and 131 (11.2%) patients from the CAP and CXR+CAP cohorts, respectively. Annualized incidence rates of CAP, CXR+CAP, S pneumonia-positive CAP, and S. pneumonia-positive CXR+CAP were 12.8, 12.5, 1.6, and 1.4 per 1000 residents, respectively. Among CXR+CAP patients, 39.7% were aged 50 to 64 years and 60.3% were aged ≥ 65 years. Incidence rates generally increased with age. The most common serotypes in S. pneumoniae-positive CXR+CAP patients were 3 (n = 15), 23F (n = 10), 18C (n = 9), and 9V (n = 6). CAP due to PCV13 serotypes is a source of morbidity among adults >50 years and may be reduced by greater access to pneumococcal vaccines.

Anticholinergic medications and risk of community-acquired pneumonia in elderly adults: a population-based case-control study.

To determine whether use of anticholinergics is associated with risk of community-acquired pneumonia in older adults. Population-based case-control study. An integrated healthcare delivery system in Washington State. Data from a nested case-control study of community-dwelling immunocompetent adults aged 65 to 94 were analyzed. Pneumonia cases (n=1,039) were ascertained according to International Classification of Diseases, Ninth Revision, codes from 2000 to 2003 and validated using chart review. Controls (n=2,022) were matched 2:1 to cases according to age, sex, and year. Anticholinergic medication exposure was ascertained using prescription data; acute use was defined as one or more prescription fills 90 days or less before the index date (date of pneumonia diagnosis), past use was defined as one or more prescription fills within the prior year but none within 90 days, and chronic use was defined as three or more prescription fills within the prior year. The reference group was those with no fills in the prior year. Conditional logistic regression was used to analyze the association between anticholinergic use and pneumonia, adjusted for comorbidities. Acute use of anticholinergics was observed in 59% of cases and 35% of controls (adjusted odds ratio (aOR)=2.55, 95% confidence interval (CI)=2.08-3.13) and past use in 17% of cases and 23% of controls (aOR=1.19, 95% CI=0.92-1.53). Chronic use of anticholinergics was observed in 53% of cases and 36% of controls (aOR 2.07, 95% CI=1.68-2.54). Results were not different for high- and low-potency anticholinergic medications. In older adults, anticholinergic medication use is associated with pneumonia risk, adding to substantial evidence suggesting that these medications are high risk.

Community-Acquired Pneumonia in Older Adults

Community-acquired pneumonia (CAP) is a common disorder with significant morbidity and mortality, particularly for older adults. Risk factors include comorbid conditions commonly found in older patients as well as immunocompromising conditions such as steroid use or administration of anti-TNF agents. While Streptococcus pneumoniae remains the most common cause of CAP in older patients, the microbiology of pneumonia differs somewhat from that of young adults with increased incidence of Staphylococcus aureus and gram-negative bacilli (especially for patients who are residents of nursing homes). The classic features of infections such as fever may not be present in older patients. Antimicrobial therapy is similar to that of younger patients and based on recent guidelines; however, there is an increased need to adjust doses based on the pharmacokinetics of the older population. Prevention includes administration of preventive vaccines and control of comorbid conditions.

Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case–control study

ObjectiveTo assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults.SettingA population-based case-control study was designed in a Mediterranean area with 860 000...

Management of community-acquired pneumonia in older adults.

Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age. Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response. Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population. Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients. This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

Adjuvant system AS02V enhances humoral and cellular immune responses to pneumococcal protein PhtD vaccine in healthy young and older adults: Randomised, controlled trials

BackgroundThe protection elicited by polysaccharide pneumococcal vaccines against community-acquired pneumonia in older adults remains debatable. Alternative vaccine targets include well-conserved pneumococcal protein antigens, such as pneumococcal histidine triad protein D (PhtD). ObjectiveTo evaluate humoral and cellular immune responses and safety/reactogenicity following immunisation with PhtD vaccine with or without adjuvant (alum or AS02V) in older (≥65 years) and young (18–45 years) healthy adults. MethodsTwo phase I/II, single-blind, parallel-group studies were conducted in 150 older and 147 young adults. Participants were randomised to receive 2 doses (months 0 and 2) of PhtD 30μg, PhtD 10μg plus alum, PhtD 30μg plus alum, PhtD 10μg plus AS02V or PhtD 30μg plus AS02V, or the 23-valent polysaccharide pneumococcal vaccine (23PPV) at month 0 with placebo (saline solution) at month 2. Safety/reactogenicity was assessed. PhtD-specific antibody, T cell and memory B cell responses were evaluated. ResultsSolicited adverse events were more common in young participants and with adjuvanted vaccines. No vaccine-related serious adverse events were reported. Although anti-PhtD geometric mean antibody concentrations (GMCs) were consistently lower in the older adult cohort than in young adults, GMCs in the older cohort following PhtD 30μg plus AS02V were comparable to those induced by plain PhtD or PhtD 30μg plus alum in the young cohort. Compared with alum adjuvant, AS02V adjuvant system was associated with an increased frequency of PhtD-specific CD4 cells in both cohorts and a significantly higher specific memory B cell response in the older cohort, similar to responses obtained in the young cohort. ConclusionThe improved immune response to PhtD vaccine containing the AS02V adjuvant system in comparison to alum suggests that the reduced immune response to vaccines in older adults can be partially restored to the response level observed in young adults. ClinicalTrials.gov identifiers: NCT00307528/NCT01767402.

Impact of admission blood glucose level on outcomes in community-acquired pneumonia in older adults

BackgroundCommunity-acquired pneumonia (CAP) is a common cause of morbidity and mortality in older adults. Although diabetes mellitus is a risk factor for pneumonia, the clinical impact of blood glucose level at the time of admission is not clear. Our goal was to examine the association between admission hyperglycemia and subsequent mortality, length of stay, and readmission outcomes in older adults with CAP.MethodsA retrospective observational study was conducted using hospital data for community-acquired pneumonia admissions in 857 persons from January 1, 2008 to December 31, 2010. We examined the effects of admission glucose level on mortality, length of stay, and 30 day readmission, adjusted for demographic factors and comorbidity.ResultsThe mean age of the sample was 64 years, and 51% of the subjects were female. Inpatient mortality occurred in 4.6% and the median length of stay was 5 days (interquartile range 3–9 days). Readmission within 30 days occurred in 17%. We found little impact of first glucose measures on in-hospital mortality (P = 0.94), length of stay (P = 0.95), and 30-day readmission (P = 0.56). Subjects 65 years and older trended towards higher in-hospital mortality. Older age, cancer, heart failure, and cirrhosis were associated with adverse outcomes.ConclusionGlucose level upon admission for community-acquired pneumonia was not associated with adverse outcomes within 30 days in older adults.

Angiotensin‐converting enzyme inhibitor use and pneumonia risk in community‐dwelling older adults: results from a population‐based case–control study

To test whether angiotensin-converting enzyme (ACE) inhibitor use is associated with decreased risk of community-acquired pneumonia in older adults. We analyzed data from a nested case-control study of community-dwelling, immunocompetent adults aged 65-94 within an integrated healthcare delivery system. Cases of ambulatory and hospitalized pneumonia from 2000 to 2003 were identified from International Classification of Disease, version 9, codes and validated using medical record review. Controls were matched to cases by age, sex, and calendar year. Using health plan pharmacy data, we defined current use as filling ≥2 prescriptions during the 180 days prior to the case's diagnosis date. We calculated standardized doses per day using World Health Organization defined daily doses. Multivariable conditional logistic regression estimated adjusted odds ratios (ORs) for pneumonia in relation to ACE inhibitor use, adjusting for comorbidity, functional and cognitive status, and other covariates from medical record review and pharmacy data. Current use of ACE inhibitors was seen in 23% (242/1039) of cases and 21% (433/2022) of controls. Lisinopril accounted for 95% of prescriptions. The OR for pneumonia comparing current use to no current use was 0.99 (95% confidence interval [CI] 0.83-1.19). The OR for use of more than two standardized daily doses per day was 1.39 (95% CI 0.93-2.06) compared to no current use. ACE inhibitor use is not associated with reduced pneumonia risk in community-dwelling older adults.

Use of Opioids or Benzodiazepines and Risk of Pneumonia in Older Adults: A Population‐Based Case–Control Study

To examine whether use of opioids or benzodiazepines is associated with risk of community-acquired pneumonia in older adults. Population-based case-control study. An integrated healthcare delivery system. Community-dwelling, immunocompetent adults aged 65 to 94 from 2000 to 2003. Presumptive pneumonia cases were identified from health plan automated data and validated through medical record review. Two controls were selected for each case with pneumonia, matched on age, sex, and calendar year. Information about opioid and benzodiazepine use came from computerized pharmacy data. Information on covariates including comorbid illnesses and functional and cognitive status came from medical record review and electronic health data. One thousand thirty-nine validated cases of pneumonia and 2,022 matched controls were identified. One hundred forty-four (13.9%) cases and 161 (8.0%) controls used prescription opioids (adjusted odds ratio (OR)=1.38, 95% confidence interval (CI)=1.08-1.76 vs nonuse). Risk was highest for opioids categorized as immunosuppressive based on immunological studies (OR=1.88, 95% CI=1.26-1.79 vs nonuse), whereas for nonimmunosuppressive opioids the OR was 1.23 (95% CI=0.89-1.69). Risk was highest in the first 14days of use (OR=3.24, 95% CI=1.64-6.39 vs nonuse). For long-acting opioids, the OR was 3.43 (95% CI=1.44-8.21) versus nonuse, whereas for short-acting opioids, it was 1.27 (95% CI=0.98-1.64). No greater risk was seen for current benzodiazepine use compared to nonuse (OR=1.08, 95% CI=0.80-1.47). Use of opioids but not benzodiazepines was associated with pneumonia risk. The differences in risk seen for different opioid regimens warrant further study.

Long-Term Exposure to Ambient Air Pollution and Risk of Hospitalization with Community-acquired Pneumonia in Older Adults

Long-Term Exposure to Ambient Air Pollution and Risk of Hospitalization with Community-acquired Pneumonia in Older Adults

Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study

BackgroundA better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia.MethodsA prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization.ResultsOf 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8%) died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2%) were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR) = 4.00, 95% confidence interval (CI) = (1.46, 10.96), P = .007), chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50), P = .014), cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31), P = .040) were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85), P = .022) was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90), P = .028). Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization.ConclusionChronic comorbidities appear to be the most important predictors of death and re-hospitalization in older adults hospitalized with community-acquired pneumonia while vitamin E supplementation was protective.

Long-Term Exposure to Ambient Air Pollution and Risk of Hospitalization with Community-acquired Pneumonia in Older Adults

Little is known about the long-term effects of air pollution on pneumonia hospitalization in the elderly. To assess the effect of long-term exposure to ambient nitrogen dioxide, sulfur dioxide, and fine particulate matter with diameter equal to or smaller than 2.5 microm (PM(2.5)) on hospitalization for community-acquired pneumonia in older adults. We used a population-based case-control study in Hamilton, Ontario, Canada. We enrolled 345 hospitalized patients aged 65 years or more for community-acquired pneumonia and 494 control participants, aged 65 years and more, randomly selected from the same community as cases from July 2003 to April 2005. Health data were collected by personal interview. Annual average levels of nitrogen dioxide, sulfur dioxide, and PM(2.5) before the study period were estimated at the residential addresses of participants by inverse distance weighting, bicubic splined and land use regression methods and merged with participants' health data. Long-term exposure to higher levels of nitrogen dioxide and PM(2.5) was significantly associated with hospitalization for community-acquired pneumonia (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.25 to 4.21; P = 0.007 and OR, 2.26; 95% CI, 1.20 to 4.24; P = 0.012, respectively, over the 5th-95th percentile range increase of exposure). Sulfur dioxide did not appear to have any association (OR, 0.97; 95% CI, 0.59 to 1.61; P = 0.918). Results were somewhat sensitive to the choice of methods used to estimate air pollutant levels at residential addresses, although all risks from nitrogen dioxide and PM(2.5) exposure were positive and generally significant. In older adults, exposure to ambient nitrogen dioxide and PM(2.5) was associated with hospitalization for community-acquired pneumonia.

Epidemiology of community-acquired pneumonia in older adults: A population-based study

This study assessed incidence, aetiology, clinical outcomes and risk factors for community-acquired pneumonia (CAP) in older adults. This was a population-based cohort study that included 11,241 community-dwelling individuals aged 65 years or more, who were followed between 2002 and 2005 in the region of Tarragona, Spain. Primary endpoints were all-cause CAP (hospitalised and outpatient) and 30-day mortality after the diagnosis. All cases were radiographically proved and validated by checking clinical records. Incidence rate of overall CAP was 14 cases per 1000 person-years (10.5 and 3.5 for hospitalised and outpatient cases, respectively). Incidence was almost three-fold higher among immunocompromised patients (30.9 per 1000) than among immunocompetent subjects (11.6 per 1000). Maximum incidences were observed among patients with chronic lung disease and long-term corticosteroid therapy (46.5 and 40.1 cases per 1000 person-years, respectively). Overall 30-day case-fatality rate was 12.7% (2% in cases managed as outpatient and 15% in hospitalised patients). Among 358 patients with an aetiological work-up, a total of 142 pathogens were found (single pathogen in 121 cases and mixed pathogens in 10 cases). Streptococcus pneumoniae was the most common pathogen (49%), followed by Pseudomonas aeruginosa (15%), Chlamydia pneumoniae (9%) and Haemophilus influenzae (6%). In multivariable analysis, the variables most strongly associated with increasing risk of CAP were history of hospitalisation for CAP in the previous 2 years and presence of any chronic lung disease. CAP remains a major cause of morbidity and mortality in older adults. Incidence rates in this study largely doubled prior rates reported in Southern European regions.