Disabled Older People Research Articles

2243 Modification effect of disability profiles on the association of blood pressure and mortality among older long-term care people

Abstract Introduction Evidence of the optimal blood pressure target for older people with disability in long-term care is limited. We aim to estimate the associations of blood pressure with all-cause and cause-specific mortality in older people with different profiles of disability. Methods This prospective cohort study was based on the government-led long-term care program in Chengdu, China, including 41,004 consecutive disabled adults aged ≥60 years. The association between blood pressure and mortality was analysed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality. Results The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild–moderate disability group (Barthel index ≥40), and a reversed J-shaped in severe disability group (Barthel index <40). In mild–moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10–1.33), compared to SBP between 135–150 mmHg. In severe disability group, SBP <150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16–1.27), compared to SBP between 150–170 mmHg. The associations were robust in subgroup analyses in terms of age, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18–1.42) in mild–moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11–1.20) in severe disability group both demonstrated an increased all-cause mortality risk. Conclusion The optimal blood pressure range was higher in older long-term care people with severe disability than those with mild–moderate disability. This study provides new evidence for optimal individualised management of blood pressure in disabled older people in long-term care settings.

The bidirectional relationship between sarcopenia and disability in China: a longitudinal study from CHARLS.

Sarcopenia and disability represent significant concerns impacting the health of older people. This study aimed to explore the bidirectional relationship between sarcopenia and disability in Chinese older people. This study recruited older people ≥60 years old from the China Health and Retirement Longitudinal Study. In phase I, the study analyzed the relation between disability and subsequent sarcopenia using multinomial logistic regression models. Conversely, in phase II, the study assessed whether sarcopenia was associated with future disability using binary logistic regression models. In phase I, 65 (16.80%) new cases of possible sarcopenia, 18 (4.65%) cases of sarcopenia, and 9 (2.33%) cases of severe sarcopenia were observed in the disabled older people and 282 (10.96%) new cases of possible sarcopenia, 97 (3.77%) cases of sarcopenia, 35 (1.36%) cases of severe sarcopenia were observed in the older people without disability. The OR (95% CI) for sarcopenia in older disabled individuals compared to those without disability was 1.61 (1.25-2.07). Adjusting for all covariates in 2011, the OR (95% CI) value for disabled individuals vs. those without disability was 1.35 (1.02-1.79). Subgroup analyses showed that disabled participants aged < 80 years were more likely to have sarcopenia (OR = 1.42, 95% CI: 1.07-1.89), and the risk of sarcopenia did not differ significantly between sex subgroups. In phase II, 114 cases (33.83%) in the possible sarcopenia patients, 85 cases (28.91%) in the sarcopenia patients, 23 cases (35.94%) in the severe sarcopenia patients, and 501 cases (16.10%) in the individuals without sarcopenia showed symptoms of disability. The OR (95% CI) for disability was 2.66 (2.08-3.40) in the possible sarcopenia patients, 2.12 (1.62-2.77) in the sarcopenia patients, and 2.92 (1.74-4.91) in the severe sarcopenia patients compared with the no sarcopenia patients. After adjusting for all covariates in 2011, the OR (95% CI) values were 2.21 (1.70-2.85) in the possible sarcopenia patients, 1.58 (1.14-2.19) in the sarcopenia patients, and 1.99 (1.14-3.49) in the severe sarcopenia patients, as compared to the older people without sarcopenia. Subgroup analyses showed that compared with men, women with possible sarcopenia had a higher risk of disability (OR = 2.80, 95% CI: 1.98-3.97). In addition, participants aged < 80 years with sarcopenia or severe sarcopenia s were more likely to have disability (OR = 2.13, 95% CI: 1.52-2.98; OR = 2.98, 95% CI: 1.60-5.54). The occurrence of disability increase the risk of sarcopenia in the older people, and baseline sarcopenia predicts the future disability in older people.

Moderating role of depression in the association between leisure activity and cognitive function among the disabled older people.

This study delves into the complex interaction between leisure activities and cognitive function in older people with disabilities, with a particular emphasis on the moderating influence of depression. Despite the well-documented cognitive benefits of leisure activities among the older people, the intricate relationship between depression and the association between leisure activities and cognitive function in this specific demographic has been rarely reported. Drawing on data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study meticulously examined a cohort of 713 participants aged 65-89 years. We constructed a moderation model to examine the impact of leisure activity on cognitive function in older people with disabilities, with depression levels as a moderating variable. We found a positive association between engagement in leisure activities and cognitive function, highlighting the potential cognitive advantages associated with leisure engagement among disabled older people. However, the present analysis also reveals a significant moderation effect of depression on this relationship, shedding light on the nuanced nature of this association. Specifically, elevated levels of depression emerge as a critical moderator, attenuating the otherwise favorable impact of leisure activities on cognitive function among older people contending with disabilities. In conclusion, the findings provide a compelling rationale for tailored interventions that comprehensively target both leisure activity engagement and concurrent depression management, effectively fostering improvements in cognitive function among the cohort of disabled older people.

From Conceptual Gaps to Policy Dialogue: Conceptual Approaches to Disability and Old Age in Ageing Research and Disability Studies

AbstractIn this study, we investigated the conceptual approaches to disability and ageing in two leading social scientific journals (Ageing &amp; Society[AS] andDisability &amp; Society[DS]) of the research fields that form the bases of policies on disability and ageing. This study aimed to identify the journals’ trajectories of conceptual development and their differences, and through that, find possible pathways for further interaction between the yet largely separate policy frameworks for disability and ageing. Our analysis showed considerable differences between the conceptual approaches of the two journals, with the dominant approach in DS being sociomaterial and individual-functional in AS. We conclude this paper by identifying the conceptual gaps in the respective journals, suggesting a further collaboration between the approaches in research as well as policies. These gaps could be potentially narrowed, leading to a constructive dialogue on older disabled people.

Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults.

Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on the propensity score matching method for data analysis. The results showed that using home and community care increased the probability of maintaining and improving physical health by 2.9%, decreased the score of depression by 0.471, and improved the score of cognitive function by 0.704. Using home and community care also increased the probability of actively participating in life by 4.1% and elevated the score of life satisfaction by 0.088. The heterogeneity analysis showed that the use of home and community care had a significant effect on promoting all health indicators in rural older adults and a more obvious promoting effect on the social adaptation of urban older adults. Using home and community care significantly promoted the multidimensional health of people aged 60 to 79 years but had no impact among people aged ≥ 80 years. The use of home and community care significantly improved all health indicators in non-disabled older adults. Whereas, it only improved the levels of cognitive function and life satisfaction in disabled older people. Using this form of care significantly improved all health indicators in those with low socio-economic status, but it only had a partial positive effect on the multidimensional health of those with high socio-economic status. Our results are of importance to the government as they may be used to further improve the quality of home and community care services for the targeted older population.

Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey

AbstractRapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.

Investigation on the quality of life of disabled elderly people in nursing institutions in Wuhan and analysis of influencing factors

Objective To investigate the present situation of the life quality of disabled elderly people in pension institutions in Wuhan and analyzes the influencing factors, so as to provide basis for relevant government departments to take measures to improve the life quality of disabled elderly people in pension institutions. Methods The subjects were evaluated by cluster random sampling and the cross-sectional investigation was carried out by using the Personal Basic Status Questionnaire, European Five Dimensional Health Scale( EQ-5D) and Social Support Revalued Scale (SSRS). Disabled elderly people in behavior, self care, daily activities and self rating in severe disability accounted for 5.28%, 2.44%, 8.73%, 0.82%. EQ-5D score of disabled elderly was related to age, gender, education level, living condition and disability time. Older, female, less educated, living alone and disabled for 3 years have lower EQ-5D score and poorer health status.Social support was positively correlated with the quality of life of disabled elderly people (P<0.05). Conclusions The quality of life of the disabled old people in the nursing institutions in Wuhan is low, so the government should formulate the nursing strategy of the disabled old people, take the particularity of the disabled old people into full consideration, and it is necessary to develop the community nursing model. Key words: Disabled elderly; Quality of life; Influencing factors

QUALITY OF LONG-TERM CARE FOR OLDER PEOPLE IN RESIDENTIAL SETTINGS – PERCEPTIONS OF QUALITY OF LIFE AND CARE SATISFACTION FROM RESIDENTS AND THEIR FAMILY MEMBERS

IntroductionPopulation ageing is a worldwide phenomenon. The very old (80 years+) is considered to be the fastest growing population group (Lafortune & Balestat, 2007; United Nations, 2009). In New Zealand (NZ), the ageing population (65+) is projected to grow to 1.28-1.37 million in 2041 (Statistics New Zealand, 2014), which means it is anticipated that the need for aged residential care will also increase. The New Zealand Health of Older People Strategy (Ministry of Health, 2002) has been emphasising the importance of planning for this growing service need. Debates about the best ways of ensuring highquality care provision for vulnerable older people are increasingly important. As the demand for residential care grows, the need to ensure standards of care and quality of life (QoL) in these settings becomes critical. Research has indicated that the perceptions of different stakeholder groups on quality of care can offer important information for care-provider organisations in identifying potential areas for improvement (Duffy, Duffy, & Kilbourne, 2001; Morrow-Howell, Proctor, & Rozario, 2001; Ryan & McKenna, 2015). The movement away from an institutional model of aged care to one that accepts resident-directed care as the guiding or defining standard of practice is part of a culture change that is positively impacting the provision of aged care services in New Zealand, Australia and around the world (Bowers et al., 2009; Brownie, Neeleman, & Noakes-Meyer, 2011; Cheek, 2011; Hamann, 2014; Miller, Booth & Mor, 2008; Petriwskyj, Parker, Brown Wilson, & Gibson, 2016). In a resident-centred approach, residents and their family members are seen as the key players in decisions about care (Hamann, 2014; Harlton, Keating, & Fast, 1998). Knowing the person, and understanding their values and beliefs, is important in the development of positive relationships which are essential in practice (Laird, McCance, McCormack, & Gribben, 2015). This study investigated older residents' perspectives on their QoL living in long-term care in New Zealand and their family members' perceptions on satisfaction with care provided.BackgroundResidential aged care services are an integral component of the accommodation and support system available for frail or disabled older people who are unable to live independently at home. These services aim to foster a sense of security and companionship, and enhance quality of life (Brownie & Horstmanshof, 2012; Oosterveld-Vlug et al., 2014). According to Sletteb0 (2008), nursing homes should provide an environment where residents' integrity and autonomy are protected and where residents can thrive (p. 22). For many older people, the transition from home to residential care may be a sudden, involuntary and disempowering experience due to their increasing dependence on facility staff for all aspects of their care (Lee, Simpson, & Froggatt, 2012; Rodgers & Neville, 2007; Tu, Wang, & Yeh, 2006; Williams, Straker, & Appelbaum, 2014). Research has long reported that daily life in an aged care facility tends to be associated with boredom and loneliness, loss of autonomy and control, lack of privacy and few opportunities for residents to construct meaningful lives (Choi, Ransom, & Wylie, 2008; Murphy, O'Shea, & Cooney, 2007; Nay, 1998; Ryan & McKenna, 2015; Timonen & O'Dwyer, 2009; Tuckett, 2007; Wilson, 1997).Many care homes try to create an atmosphere of homeliness, but this has been difficult, even in the smallest of homes (Peace & Holland, 2001; Williams et al., 2014). This may be due to facilities historically focussing primarily on clinical outcomes relating to medical and physical care, and institutional rationales such as low levels of staffing and financial constraints, which result in residents' loss of autonomy and control (Beringeer & Crawford, 2003; Davis, Byers, & Walsh, 2008; Jilek, 2000; Oostervekd-Vlug et al. …

Reconstructing Identity of Older People in Using Day Care Services in Taiwan: A Grounded Theory Study

Adult day care centers provide a means whereby frail or disabled older people can remain living at home particularly when their family care-givers engage in waged work. In Taiwan, adult day care services appear to meet the cultural needs of both older people and their families for whom filial care is vital. Little research attention has been paid to the use of day care services in Taiwan, the uptake rate of which is low. This grounded theory study explored the ways in which older people and family care-givers construct meanings around the use of day care services in Taiwan.

Disability and Life Satisfaction in Italy

During the last decades, the socio-economic policy agenda has devoted an increasing attention to the inclusion of disabled people into society. It follows that understanding the drivers of life outcomes and conditions of disabled people is essential to analyze the sources of disadvantaged positions. This paper brings evidence on the predictors of life satisfaction of disabled people in Italy, focusing on four specific dimensions (relations with relatives and friends, economic conditions, and leisure time) and analyzing information on people with functional limitations and health problems, as provided by the 2011 ISTAT survey. Estimation results show that household structure, health and disability status affect life satisfaction more significantly than personal and income variables. Education attainments significantly affect satisfaction with the economic conditions. In addition, support in daily activities may increase satisfaction with economic conditions and leisure time, suggesting that providing non-monetary support would be effective in increasing life satisfaction, especially in those domains requiring freedom of movement. Finally, we find that older disabled people are, on average, more satisfied than younger disabled people, while gender is relevant when interacted with the household type.

A Study of Older People with Disability: Evidence from Two Cosmopolitan Cities

It has been widely understood that disability is a fact of human diversity. The people with disability are still not freely functional in society. There are still a considerable number of social circumstances that need to be improved and environmental barriers removed to help this group of people live boundlessly in the community. By employing questionnaire survey, the study explores the social exclusion and life circumstances experienced by older people with disability in two cosmopolitan cities: urban Hong Kong and Shanghai. The purposes of the present study are two-fold: (1) it aims to investigate the link between social exclusion and their life satisfaction, and explores how social exclusion affects the life satisfaction of disabled elderly; (2) it aims to identify the differences in the experience of social exclusion and its relationship with life satisfaction in the two cities. Via proportional sampling, 710 participants were interviewed, among whom 660 were valid. Results showed that disability and functional capacity was associated with the life satisfaction, with neighborhood exclusion as the most salient feature of social exclusion. This implies that social environment is not inclusive for disabled older people under many circumstances. Implications for how to achieve an inclusive society, especially for disabled older adults, are then deliberated in turn.

Depression and Self-Reported Disability Among Older People in Western Europe

To analyze the existing levels of depression among older people (aged 50 or older) with and without disabilities at a European level. We analyse and compare the levels of depression among people with and without disabilities in 11 Western European countries through the use of the indicator EURO-D. We employ a logistic model for each country to estimate the effects of self-reported disability on the likelihood of being depressed. Older people with disabilities suffer higher levels of depression as compared with their nondisabled counterparts, especially among women. Furthermore, significant regional differences in the levels of depression are found. The high prevalence of depression among disabled older individuals is a phenomenon of especial interest and medical, social, and economic relevance within Europe and has important effects on the levels of well-being, employment and income reported by all older people in general, and disabled older people in particular.

The MonAMI project: the social benefits of telecare

Introduction: There are widespread concerns around the accessibility of mainstream technology which remains underdeveloped for the needs of many older people 1. The Mainstreaming on Ambient Intelligence (MonAMI) project 2, funded under the EU FP6 framework in the area of e-Inclusion, developed an open technology platform and series of ‘telecare’ services designed to be accessed using mainstreamed devices (e.g. mobile telephones, personal computers). A field trial was conducted to evaluate the technology in the homes of disabled older people in three communities across Europe. Aims: The primary aim of the MonAMI trial was to evaluate the acceptability and usefulness of the services in terms of whether they enable older people with needs to live independently and maintain a good quality of life. The secondary aim was to validate the technical and economic feasibility of delivering telecare services, using an open platform, in living community contexts. Methods: The MonAMI system was evaluated in a three-month field trial in the cities of Kosice (Slovakia), Stockholm (Sweden) and Zaragoza (Spain). Trial participants (users) included people over 65 years, with a varying range of physical, cognitive and sensorial impairments. In each of the users’ homes a bouquet of alert, home monitoring and home control services were installed and configured to users’ individual needs and lifestyle. Face-to-face, semi-structured interviews were held at baseline and at post-trial follow-up, collecting data on users’ level of independence, health and wellbeing status, social networking, perceptions of safety, and acceptance of the services. Significance tests and regression analyses were performed to measure the impact of the services on users’ quality of life. Results: Sixty-eight users were recruited to the trial. The mean age was 78 years, 74% were women and 93% lived alone. Most users reported disabilities related to their legs and knees and the mean self-rated EQ5D-VAS3 health score was 63.8. In general, users with better self-rated independence 4 and health scores at baseline found the services more helpful compared to users with poorer ratings. However, specific analyses revealed the services had positive effects on perceptions of safety for users with a greater number of disabilities as compared to those with fewer disabilities (Odds ratio 2.51, p<0.05). Users with leg impairments conveyed feeling more energetic as compared to those without such impairments (Odds ratio 7.49, p<0.05); while users living alone confirmed that the services were helpful for their social networking5 as compared to users living with others (Odds ratio 2.49, p<0.1). Collectively, significantly more than 50% of users (70.6% p<0.001) rated the acceptability and usefulness of MonAMI services highly. Moreover many users stated that if possible, they would continue using the MonAMI system beyond the trial. Conclusions: Overall, the trial results are promising; demonstrating that the MonAMI telecare services are beneficial for older people with needs. The trial also confirmed the potential of deploying and providing continuous services using MonAMI technology across diverse health and social care systems in Europe, l

Social inclusion through ageing-in-place with care?

ABSTRACTThe onset of ill-health and frailty in later life, within the context of the policy of ageing-in-place, is increasingly being responded to through the provision of home care. In the philosophy of ageing-in-place, the home provides for continuity of living environment, maintenance of independence in the community and social inclusion. The provision of assistance to remain at home assumes continuity in the living environment and independence in the organisation of daily life and social contact. This paper explores the changes that occur as a result of becoming a care recipient within the home and concludes that the transition into receiving care is characterised by discontinuity and upheaval which tends to reinforce social exclusion. We draw on the rites of passage framework, which highlights social processes ofseparation, liminality and reconnection, in analysing this transition to enhance understanding of the experience and gain insights to improve the policy and practice of home care. Separation from independent living leads to a state of liminality. The final stage in the rites of passage framework draws attention to reconnections, but reconnection is not inevitable. Reconnection is, however, an appropriate goal for the care sector when supporting frail or disabled older people through the transition into becoming a home-care recipient.

Establishing a ‘train the trainer’ education model for clinical skills development

Demographic trends and service reform present healthcare providers with the challenge of developing appropriate resources to manage increasing numbers of sick and disabled older people. But these changes bring increased opportunities for nursing, and the expansion of the nursing role is crucial as health services strive to meet the changing needs of older people. Against a background of reforms in Ireland and backed by an education and training needs analysis of nursing staff, two stakeholders devised a model of education that would best meet identified demands. This article sets out a model for skill attainment that acknowledges the diversity of care settings and improves the sustainability of training provided. Advantages and disadvantages are discussed, and lessons learned are shared.

Factors related to institutionalization among disabled older people; a two‐year longitudinal study

Factors related to institutionalization among disabled older people; a two‐year longitudinal study

Care by Spouses, Care by Children: Projections of Informal Care for Older People in England to 2031

The future market costs of long-term care for older people will be affected by the extent of informal care. This paper reports on projections of receipt of informal care by disabled older people from their spouses and (adult) children to 2031 in England. The paper shows that, over the next 30 years, care by spouses is likely to increase substantially. However, if current patterns of care remain the same, care by children will also need to increase by nearly 60 per cent by 2031. It is not clear that the supply of care by children will rise to meet this demand.

Home is Where the Heart Stopped: Panopticism, Chronic Disease, and the Domestication of Assistive Technology

ABSTRACTThe notions of housing and the home have shifted considerably over the past decades given the significant changes in technological developments, demographics and the constitution of the family nexus. One of the areas in which architecture, design and planning have been responding relates to the growing needs of an ageing population with increasing leisure time as well as exposure to disability or chronic diseases.Regarding the treatment or rehabilitation from illness, sophisticated medical technologies were once the exclusive domain of hospitals and specialist practices but are becoming increasingly available in the home. The idea behind their recent proliferation is to save money and time for health services as well to allow outpatients a greater participation in their own recovery by avoiding institutional care. Unfortunately, however, studies into the development of assistive technology innovations have largely overlooked the user's changing perceptions about their own needs and towards the ways in which the innovations in question become appropriated into their everyday lives. Additionally, little is known about how they and their extended support network of carers, friends, kin or partners actually perceive the impacts of illness on domestic lifestyles. This paper addresses these issues. It examines the mainstream implementation of telecare in relation to facilitating the independence of older disabled people in their domestic space. From a case study of chronic heart failure sufferers over sixty living in the Barnsley area, we evaluate the expectations, benefits, drawbacks and social meanings concerning a forthcoming pilot installation of such a home-based health monitoring scheme.

Factors affecting completion of the SF-36 in older people

to examine the influence of specific clinical impairments and disabilities on the completion of the SF-36 health status measure among older people. Prospective observational study. An SF-36 was administered to 245 subjects aged 65 years and older. Subjects were chosen by sampling from a variety of inpatient, outpatient and community sources to ensure a range of relevant disabilities. response rates, overall rates of completion, completion of individual questions and time taken to complete. severe functional impairment (Barthel index < or = 12) was found in 22.4% (51/228), cognitive impairment in 54.1% (132/244), depressed mood in 77.0% (151/196) and visuospatial dysfunction in 71.3% (134/188). The median number of impairments was three (interquartile range 1-4). Specific physical impairments were visual in 13.2% (31/235), hearing in 30.2% (74/245), impaired manual dexterity in 18.0% (44/245) and dysphasia in 23% (55/239). In multivariate analyses, global functional impairment (P = 0.006), cognitive impairment (P = 0.0001) and impaired manual dexterity (P = 0.005) were significantly associated with more dimensions uncompleted, whilst cognitive impairment (P = 0.001), age (P = 0.006) and visuospatial dysfunction (P = 0.0003) were significantly associated with longer completion times. the most striking finding of the study was that global rather than specific physical and mental dysfunction was associated with the inability to complete the SF-36 questionnaire. The difficulty appears to lie in the performance of a complex task, rather than with specific aspects of the task which could be overcome by adaptation or aids. Our experience is that this relatively complex questionnaire does not adequately measure functional health status in disabled older people because of non-completion and may therefore overestimate the health of populations.

Preventive Strategies for Aspiration Pneumonia in Elderly Disabled Persons

Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., 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 contained in the vagal and glossopharyngeal nerves, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, can 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 can reduce 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. The main theme of this review is to discuss how pneumonia develops in disabled older people and to suggest preventive strategies that may reduce the incidence of pneumonia among these subjects.