Pneumonia In Elderly People Research Articles

カプサイシン軟膏による外耳道刺激は高齢認知症患者の肺炎を予防する

Abstract Objective In the present study, we examined the effects of daily application of capsaicin ointment to the external auditory canal for 6 months on the development of pneumonia in elderly dementia patients at high risk of aspiration. Methods Twenty-nine oldest-old bedridden dementia inpatients at high risk of aspiration were enrolled in the present study. Ointment containing 0.025% capsaicin was applied to each external auditory canal with a cotton swab alternatively once a day for 6 months. Results The incidence of pneumonia during the 6 months before the intervention was 1.80 ± 0.37 in these patients. However, this incidence significantly decreased to 0.40 ± 0.29 (p Conclusion These findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold’s ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.

Association between coffee and green tea intake and pneumonia among the Japanese elderly: a case-control study

A large prospective cohort study in the United States examined the association between coffee intake and overall and cause-specific mortality and showed a inverse association between pneumonia and influenza deaths and coffee intake. In Japan, the mortality rate of pneumonia in elderly people is high, and its prevention is an important issue. The present study investigated the association between coffee and green tea intake and pneumonia among the elderly. The design was a hospital-based case control study. The cases were patients over 65 years old newly diagnosed as pneumonia. As a control, patients with the same sex and age (range of 5 years) who visited the same medical institution around the same time (within 2 months after examination of the case) for a disease other than pneumonia were selected. There were two controls per case. Odds ratio (OR) and 95% confidence interval (CI) for pneumonia of coffee and green tea intake during the past month were calculated using a conditional logistic regression model. A total of 199 cases and 374 controls were enrolled. When compared to those who do not drink coffee, the OR for pneumonia of those who drink less than one cup of coffee per day was 0.69 (95% CI 0.39–1.21), OR of those who drink one cup was 0.67 (0.38–1.18), and OR of those who drink two or more cups was 0.50 (0.28–0.88) (Trend p = 0.024). No association was found between pneumonia and green tea consumption. This study suggested a preventive association between coffee intake over 2 cups per day and pneumonia in the elderly.

Comparative Study of Bacterial Growth Inhibitory Effect of Three Types of Mouthwashes Marketed in Japan Containing Povidone Iodine, Benzethonium Chloride, and Chlorhexidine Gluconate by Bacterial Culture

Purpose: Pathogenic microorganisms in saliva are thought to be a major cause of surgical site infection in patients who have undergone surgery for head and neck or upper digestive tract cancers, and a common cause of postoperative pneumonia and aspiration pneumonia in elderly people. Gargling with a mouthwash containing an antiseptic agent is recommended to control salivary pathogen populations, but it is not clear which antiseptic agents are most effective. The purpose of this study is to examine the potencies of three antiseptic mouthwashes marketed in Japan against salivary bacteria.

COVID-19 pandemic and the incidence of community-acquired pneumonia in elderly people.

The impact of the COVID-19 pandemic on the incidence of community-acquired pneumonia in elderly people remains uncertain. We compared the number of elderly patients admitted to our hospital for community-acquired pneumonia from January to June 2020 to the numbers from the same period in each of the last three years. The number of patients began decreasing in February 2020, and by April 2020 the number was significantly lower than those from the same period in the three years prior. There is no evidence regarding the impact of general infection control measures, such as wearing a face mask or washing one's hands, on the development of community-acquired pneumonia, because causative bacteria are not believed to be transmitted from human to human. However, these measures might have indirectly contributed to a decreased number of cases through the prevention of common viral infections which could be a trigger of community-acquired pneumonia.

Analysis of clinical outcomes in elderly patients with impaired swallowing function.

Japan is the world's leading aging society, and increasing medical expenses for elderly people is an urgent issue. Since aspiration pneumonia in elderly people with impaired swallowing function is a huge problem in Japan, their expected long-term clinical course should be clarified. Accordingly, we collected data from 991 elderly (≥75 years old) patients whose swallowing function was evaluated by Kitasato Institute Hospital's speech therapists (January 1, 2010 to December 31, 2017). We analyzed the relationship between swallowing function and the subjects' long-term prognosis. To clarify the prognostic factors of patients with dysphagia, we obtained their clinical information (age, gender, activities of daily living, nutritional status, availability of alternative feeding pathways such as percutaneous endoscopic gastrostomy, and cognitive function). We confirmed 372 death cases and stratified the cases into three groups using Fujishima's swallowing ability grade, which is used to predict elderly people's real-world life expectancy. Results showed the median survival days were 331 and 952 days in Groups I (Grades 1-3, n = 308) and II (Grades 4-6, n = 153), respectively, whereas the median survival days for Group III (Grades 7-10, n = 530) could not be calculated. We conducted a multivariate analysis using the Cox proportional hazards model with Group I, which revealed that initial grade and percutaneous endoscopic gastrostomy were significant prognostic factors for the subjects' long-term survival. Nevertheless, further discussion is necessary, particularly to determine advanced care planning regarding indications for alternative feeding pathways in elderly patients with severe dysphagia, since percutaneous endoscopic gastrostomy could significantly prolong their survival.

Guidelines for the Prevention of Coronavirus Pneumonia in Elderly People

Elderly people have weakened immune functions and suffer from many underlying chronic diseases. They are at high risk of contracting COVID-19. Most of the patients who died of COVID-19 were either elderly persons or patients with underlying diseases. Therefore, it is important to improve the knowledge and awareness of the prevention of COVID-19 among the elderly. In this guideline, we analyze the susceptibility of the elderly to critical illness, and the causes of this vulnerability. Based on the characteristics of the prevention and control of COVID-19 among elderly people, we propose recommendations from three perspectives: infection source, transmission route, and susceptible population. These measures can help reduce the infection of the elderly with COVID-19. Keywords: Elderly people, COVID-19, prevention, SARS-CoV-2

OmpA of Klebsiella pneumoniae ATCC 13883 induces pyroptosis in HEp-2 cells, leading to cell-cycle arrest and apoptosis

Klebsiella pneumoniae is an opportunistic pathogenic bacterium that commonly causes pneumonia in elderly people. OmpA, a toxin that is highly expressed in the outer membrane of the bacterium, is one of the primary factors implicated in the pulmonary pathogenesis of K. pneumoniae. To evaluate the associated pyroptosis mechanism of infection, the ompA gene was cloned, and the protein was expressed, extracted, and used to treat human larynx epithelial cells. We observed that OmpA induces reactive oxygen species production and cell-cycle arrest in the G2/M phase in host cells, leading to subsequent apoptosis. Moreover, OmpA was found to induce IL-1β and IL-18 production in host cells, resulting in caspase-1 activation, which simultaneously stimulated pyroptosis, thus leading to the death of the host cells. We next sought to examine differential gene expression via RNA sequencing to better elucidate the mechanisms associated with these cellular changes, and found that genes associated with these pathways were more highly expressed in OmpA-treated cells than in K. pneumoniae-infected cells. Thus, cell-cycle arrest, apoptosis, and pyroptosis may serve as the primary defenses employed by host cells against OmpA. These results provide novel insights into the host defense against K. pneumoniae infection.

Aural stimulation with capsaicin prevented pneumonia in dementia patients

ObjectiveIn the present study, we examined the effects of daily application of capsaicin ointment to the external auditory canal for 6 months on the development of pneumonia in elderly dementia patients at high risk of aspiration. MethodsTwenty-nine oldest-old bedridden dementia inpatients at high risk of aspiration were enrolled in the present study. Ointment containing 0.025% capsaicin was applied to each external auditory canal with a cotton swab alternatively once a day for 6 months. ResultsThe incidence of pneumonia during the 6 months before the intervention was 1.80±0.37 in these patients. However, this incidence significantly decreased to 0.40±0.29 (p<0.01) during the 6 months of the alternative application of capsaicin ointment to each auditory canal. No adverse effect such as otalgia was observed. ConclusionThese findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold’s ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.

Clinical observation of tongue coating of perioperative patients: factors related to the number of bacteria on the tongue before and after surgery

BackgroundIncreased amount of tongue coating has been reported to be associated with increased bacteria count in the saliva and aspiration pneumonia in elderly people. However, the implications of tongue coating for prevention of postoperative complications in patients undergoing major oncologic or cardiac surgery has not been well documented. The purpose of this study is to investigate the number of bacteria on the tongue before and after surgery and factors affecting it.MethodsFifty-four patients who underwent oncologic or cardiac surgery under general anesthesia at Nagasaki University Hospital were enrolled in the study. Various demographic, tumor-related, treatment-related factors, and the number of bacteria on the tongue and in the saliva were examined, and the relationship among them was analyzed by Mann-Whitney U test, Spearman rank correlation coefficient, or multiple regression.ResultsBefore surgery, no significant factors were correlated with the number of bacteria on the tongue, and there were no relationship between bacteria count on the tongue and that in the saliva. On the next day after surgery, bacteria on the tongue increased, and sex, periodontal pocket depth, feeding condition, dental plaque, blood loss, and bacteria in the saliva were correlated with bacteria on the tongue by a univariate analysis. A multivariate analysis showed that feeding condition, and amount of dental plaque were correlated with the number of bacteria.ConclusionsIncreased number of bacteria on the tongue was associated with feeding condition and amount of dental plaque. Further studies are necessary to clarify the clinical significance of dental coating in perioperative oral management of patients undergoing oncologic or cardiac surgery.

Bacterial Pneumonia in Elderly Japanese Populations.

Bacterial pneumonia is one of the most important infectious diseases in terms of incidence, effect on quality of life, mortality, and impact on society. Pneumonia was the third leading cause of death in Japan in 2011. In 2016, 119 650 Japanese people died of pneumonia, 96% of whom were aged 65 years and above. The symptoms of pneumonia in elderly people are often atypical. Aspiration pneumonia is seen more frequently than in young people because of swallowing dysfunction in the elderly. The mortality rate is also higher in the elderly than in young people. In Japan, the population is aging at an unprecedented rate, and pneumonia in the elderly will be increasingly important in medicine and medical economics in the future. To manage pneumonia in the elderly, it is important to accurately evaluate its severity, administer appropriate antibiotic treatment, and implement effective preventive measures.

Efficacy of a New Post-Mouthwash Intervention (Wiping Plus Oral Nutritional Supplements) for Preventing Aspiration Pneumonia in Elderly People: A Multicenter, Randomized, Comparative Trial

Background/Aims: Aspiration pneumonia is a common cause of death among the elderly (≥90-year-old) in nursing homes. Studies suggest that its incidence could be reduced by oral care interventions. We aimed to evaluate the efficacy of a new oral care intervention: wiping plus oral nutritional supplements (ONS). Methods: This prospective observational study was conducted in 252 patients (age 88.0 ± 6.5 years) in 75 nursing homes, rehabilitation hospitals, and other care facilities. Patients were randomly divided into an intervention group (n = 74) and a control group (n = 107), whose members received conventional oral care. Body mass index, activities of daily living (Barthel index), and complete blood count and biochemistry parameters were measured at 2, 4, 6, and 8 months. Results: The cumulative incidence of pneumonia at 8 months tended to be lower in the intervention than in the control group (7.8 vs. 17.7%, p = 0.056) and was significantly lower for men in the intervention group (p = 0.046). Conclusions: Our new intervention “wiping plus providing ONS” method appears to help prevent aspiration pneumonia, thereby reducing mortality risk. In this study, we disseminate information on how this method is used in Japan.

Estimating The Excess Costs of Community-Acquired Pneumonia In Elderly People In Japan

Estimating The Excess Costs of Community-Acquired Pneumonia In Elderly People In Japan

The relationship of oral health with general health and NCDs: a brief review

Oral health is closely related to systemic health. Periodontitis, a chronic inflammatory disease which is highly prevalent worldwide, interacts with a variety of noncommunicable diseases (NCDs). It is a risk factor in the complex pathogenesis of diabetes mellitus and cardiovascular disease and plays a role in the development of endocarditis and recurrent pneumonia in elderly people. However, the available data may be interpreted in different ways, and more and better-designed studies are still needed to answer relevant questions about the causal role of periodontitis in NCDs. What is clear is that periodontitis contributes to the systemic inflammatory burden. As periodontitis shares many common risk factors with NCDs, close collaboration between physicians and dentists is needed to increase the chance of early detection and improve the prevention and control of these conditions.

SUN-P042: Efficacy of a New Intervention “Wiping Plus Providing Oral Nutritional Supplements” in Preventing Aspiration Pneumonia in Elderly People: A Multicenter, Randomized Comparative Trial

SUN-P042: Efficacy of a New Intervention “Wiping Plus Providing Oral Nutritional Supplements” in Preventing Aspiration Pneumonia in Elderly People: A Multicenter, Randomized Comparative Trial

PRS15 - Recurrent Episodes Of Pneumonia In Elderly People From Private Brazilian Perspective

PRS15 - Recurrent Episodes Of Pneumonia In Elderly People From Private Brazilian Perspective

Dysphagia, dystussia, and aspiration pneumonia in elderly people.

Despite the development and wide distribution of guidelines for pneumonia, death from pneumonia is increasing due to population aging. Conventionally, aspiration pneumonia was mainly thought to be one of the infectious diseases. However, we have proven that chronic repeated aspiration of a small amount of sterile material can cause the usual type of aspiration pneumonia in mouse lung. Moreover, chronic repeated aspiration of small amounts induced chronic inflammation in both frail elderly people and mouse lung. These observations suggest the need for a paradigm shift of the treatment for pneumonia in the elderly. Since aspiration pneumonia is fundamentally based on dysphagia, we should shift the therapy for aspiration pneumonia from pathogen-oriented therapy to function-oriented therapy. Function-oriented therapy in aspiration pneumonia means therapy focusing on slowing or reversing the functional decline that occurs as part of the aging process, such as "dementia → dysphagia → dystussia → atussia → silent aspiration". Atussia is ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration, which leads to the development of life-threatening aspiration pneumonia. Research pursuing effective strategies to restore function in the elderly is warranted in order to decrease pneumonia deaths in elderly people.

Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing care

Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing careAbstractAim: To identify signs predictive of pneumonia development that can be recognized at nursing homes where limited medical staff and equipment are available.Methods: Subjects were 761 elderly individuals needing nursing care (172 men 594 women; mean age, 86.8±7.2 years), from 42 nursing homes across Japan who could eat orally and had not received antibiotic treatment during the previous three months. Dental hygienists examined each subject for wet hoarseness during and after eating a meal as a sign of impaired swallowing function, prolongation of mealtime length, refusal of oral care, dry mouth and halitosis. Data on the subjects’ activities of daily living, body mass index (BMI) calculated from body height and weight as a measure of nutritional status, and underlying diseases were transcribed from the medical records kept at each nursing home.Results: During the study period, pneumonia occurred in 116 subjects (44 men, 72 women). Significant associations with pneumonia development were identified for nutritional status (P = 0.007) and swallowing function (P = 0.002). Analysis including comorbid conditions further identified heart disease (P = 0.03).Conclusion: In this study, decreased BMI and wet hoarseness during and after eating a meal were identified as signs of pneumonia risk at nursing homes.

Association between monovalent influenza A (H1N1) pdm09 vaccine and pneumonia among the elderly in the 2009–2010 season in Japan: A case-control study

We investigated the association between monovalent influenza A (H1N1) pdm09 (H1N1pdm) vaccine and pneumonia in elderly people. Study design was a hospital-based, matched case-control study. Cases comprised patients ≥65 years old who had been newly diagnosed with pneumonia. For each case, 2 controls were defined as individuals with other diseases (not pneumonia) who were matched by sex, age, entry date, and the visited hospital. Study period was the interval from 1 September 2009 until 30 September 2010. Because a pandemic of influenza A (H1N1) occurred during study period, we analyzed selected subjects who had enrolled during the influenza A (H1N1) pandemic. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for pneumonia in H1N1pdm-vaccinated subjects compared with unvaccinated subjects using a conditional logistic regression model to assess the association between H1N1pdm vaccine and pneumonia. The subjects during the period of the influenza A (H1N1) pandemic were 20 cases and 40 controls. Subjects who had received H1N1pdm vaccine showed a significantly decreased OR for pneumonia (OR = 0.10, 95% CI = 0.01–0.98) compared with unvaccinated subjects. In conclusion, H1N1pdm vaccination may have prevented pneumonia among the elderly during the 2009–2010 influenza A (H1N1) pandemic in Japan.

Ecological study on mortality from influenza and pneumonia before and after influenza vaccination in the Northeast and South of Brazil

The study compared mortality from influenza and pneumonia in elderly people (65 years or older) before and since implementation of influenza vaccination in the South and Northeast regions of Brazil. Official population and mortality data were retrieved from government agencies to estimate weekly mortality rates. The Serfling model was used to identify influenza outbreaks and estimate the mortality attributable to them. In the South, the vaccination period showed a major reduction in mortality from influenza and pneumonia and in the number and duration of influenza outbreaks. These results were interpreted as consistent with the hypothesis of the vaccination program's effectiveness. In the Northeast, there was an increase in mortality from influenza and pneumonia during vaccination, which was associated with a quality improvement in recording causes of death in the elderly. An increase was also seen in mortality attributable to influenza outbreaks, suggesting a mismatch between the period in which vaccination is conducted and the relevant climatic characteristics for influenza transmission.

1. Novel Strategies for Preventing Aspiration Pneumonia in Elderly People.

1. Novel Strategies for Preventing Aspiration Pneumonia in Elderly People.