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Recent Advances in Pneumonia in Older People

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 July 2022) | Viewed by 42959

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Special Issue Editors

Prof. Dr. Satoru Ebihara

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Guest Editor

Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo 143-8541, Japan
Interests: pneumonia; dysphagia; dystussia; rehabilitation; frailty; sarcopenia

Dr. Takae Ebihara

E-Mail Website
Co-Guest Editor

Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
Interests: pneumonia; cough; dyspnea; geriatric medicine

Special Issue Information

Dear Colleagues,

Despite the development of strong antibiotics, pneumonia death is increasing rapidly due to the growth of the aged population. Since pneumonia death mainly affects older people, we should focus on not only pathogen but also host defense matter to overcome this situation. Pathogens range from bacteria to viruses and unknown emerging infectious diseases. Host defense includes not only immune function, but also physical function and other physiological functions. Geriatric functional declines such as sarcopenia, dysphagia, dystussia, and frailty play pivotal roles in development of pneumonia in older people. Therefore, the remedy for pneumonia in older people should be function-oriented therapy in addition to pathogen-oriented therapy. Comprehensive approaches with a multidisciplinary team are also important. We welcome original articles and reviews concerning various aspects of pneumonia in older people such as epidemiology, pathophysiology, new preventive strategies, and trending topics.

Prof. Dr. Satoru Ebihara
Dr. Takae Ebihara
Guest Editors

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Keywords

bacteria
virus
antibiotics
aspiration
dysphagia
dystussia
cough reflex
swallowing reflex
multidisciplinary team
rehabilitation

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Published Papers (11 papers)

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Editorial

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3 pages, 189 KiB

Open AccessEditorial

Importance of Skeletal Muscle and Interdisciplinary Team Approach in Managing Pneumonia in Older People

by Satoru Ebihara, Tatsuma Okazaki, Keisuke Obata and Takae Ebihara

J. Clin. Med. 2023, 12(15), 5093; https://doi.org/10.3390/jcm12155093 - 3 Aug 2023

Viewed by 1042

Abstract

Pneumonia is the most frequent lower respiratory tract disease and a major cause of morbidity and mortality globally [...] Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

Research

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10 pages, 963 KiB

Open AccessArticle

Association between Low Forced Vital Capacity and High Pneumonia Mortality, and Impact of Muscle Power

by Nanako Shiokawa, Tatsuma Okazaki, Yoshimi Suzukamo, Midori Miyatake, Mana Kogure, Naoki Nakaya, Atsushi Hozawa, Satoru Ebihara and Shin-Ichi Izumi

J. Clin. Med. 2023, 12(9), 3272; https://doi.org/10.3390/jcm12093272 - 4 May 2023

Cited by 5 | Viewed by 1740

Abstract

Impaired % predicted value forced vital capacity (% FVC) is related to higher all-cause mortality in aged adults, and strong muscle force may improve this relationship. A muscle disease, sarcopenia, causes higher mortality. We aimed to identify the unknown disease that relates impaired % FVC with higher mortality in aged adults among the three major leading causes of death, and the effect of strong leg force on this relationship. Cox proportional hazard model analyzed the longitudinal Tsurugaya cohort that registered 1048 aged Japanese for 11 years. The primary outcome was the relationship between % FVC and mortality by cancer, cardiovascular disease, or pneumonia. Exposure variables were % FVC or leg force divided by 80% or median values, respectively. The secondary outcome was the effects of leg force on the relationship. Among the diseases, % FVC < 80% was related only to higher pneumonia mortality (hazard ratio [HR], 4.09; 95% CI, 1.90–8.83) relative to the % FVC ≥ 80% group before adjustment. Adding the leg force as an explanatory variable reduced the HR to 3.34 (1.54–7.25). Weak leg force might indicate sarcopenia, and its prevention may improve higher pneumonia mortality risk related to impaired % FVC, which we may advise people in clinical settings. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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11 pages, 1464 KiB

Open AccessArticle

Use of Maximum Tongue Pressure Values to Examine the Presence of Dysphagia after Extubation and Prevent Aspiration Pneumonia in Elderly Emergency Patients

by Ryo Ichibayashi, Hideki Sekiya, Kosuke Kaneko and Mitsuru Honda

J. Clin. Med. 2022, 11(21), 6599; https://doi.org/10.3390/jcm11216599 - 7 Nov 2022

Cited by 3 | Viewed by 1879

Abstract

Background: Tongue pressure values in patients with dysphagia are reported to be significantly lower than those in healthy controls. The aim of this study was to measure the maximum tongue pressure (MTP) values after extubation in order to assess the presence of post-extubation dysphagia for the safe initiation of oral intake in elderly patients. Methods: Data from 90 patients who were extubated after mechanical ventilation under tracheal intubation were collected retrospectively. The patients were divided into two groups as follows: normal group (those who did not develop aspiration pneumonia after extubation; median age 62 years) and aspiration group (those who developed aspiration during the evaluation period; median age 75 years). The MTP values were measured at 6 h, 24 h, 3 days, and 7 days after extubation. Results: The values were significantly increased 24 h after extubation in the normal group (p < 0.05). Alternatively, no increase was observed even after 1 week of extubation in the aspiration group, and the values were significantly lower than those in the normal group. The cutoff values at 6 and 24 h after extubation, which were measured using the receiver operator characteristic (ROC) curve, were 17.8 and 23.2 kpa, respectively; furthermore, the results of these assessments were strongly related to the development of aspiration 6 h after extubation (χ²-value: 6.125; p = 0.0133). Conclusions: The presence of post-extubation dysphagia in patients who are intubated for ≥24 h can be predicted based on age and the MTP values at 6 h after extubation. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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12 pages, 944 KiB

Open AccessArticle

Physical Inactivity and Sedentarism during and after Admission with Community-Acquired Pneumonia and the Risk of Readmission and Mortality: A Prospective Cohort Study

by Camilla Koch Ryrsø, Arnold Matovu Dungu, Maria Hein Hegelund, Daniel Faurholt-Jepsen, Bente Klarlund Pedersen, Christian Ritz, Birgitte Lindegaard and Rikke Krogh-Madsen

J. Clin. Med. 2022, 11(19), 5923; https://doi.org/10.3390/jcm11195923 - 7 Oct 2022

Cited by 3 | Viewed by 2936

Abstract

Background: Bed rest with limited physical activity is common during admission. The aim was to determine the association between daily step count and physical activity levels during and after admission with community-acquired pneumonia (CAP) and the risk of readmission and mortality. Methods: A prospective cohort study of 166 patients admitted with CAP. Step count and physical activity were assessed with accelerometers during and after admission and were categorised as sedentary, light, or moderate-vigorous physical activity. Linear regression was used to assess the association between step count and length of stay. Logistic regression was used to assess the association between step count, physical activity level, and risk of readmission and mortality. Results: Patients admitted with CAP were sedentary, light physically active, and moderate-to-vigorous physically active 96.4%, 2.6%, and 0.9% of their time, respectively, with 1356 steps/d. For every 500-step increase in daily step count on day 1, the length of stay was reduced by 6.6%. For every 500-step increase in daily step count during admission, in-hospital and 30-day mortality was reduced. Increased light and moderate-to-vigorous physical activity during admission were associated with reduced risk of in-hospital and 30-day mortality. After discharge, patients increased their daily step count to 2654 steps/d and spent more time performing light and moderate-to-vigorous physical activity. For every 500-step increase in daily step count after discharge, the risk of readmission was reduced. Higher moderate-to-vigorous physical activity after discharge was associated with a reduced risk of readmission. Conclusions: Increased physical activity during admission was associated with a reduced length of stay and risk of mortality, whereas increased physical activity after discharge was associated with a reduced risk of readmission in patients with CAP. Interventions focusing on increasing physical activity levels should be prioritised to improve the prognosis of patients admitted with CAP. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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10 pages, 672 KiB

Open AccessArticle

High Mortality in an Older Japanese Population with Low Forced Vital Capacity and Gender-Dependent Potential Impact of Muscle Strength: Longitudinal Cohort Study

by Midori Miyatake, Tatsuma Okazaki, Yoshimi Suzukamo, Sanae Matsuyama, Ichiro Tsuji and Shin-Ichi Izumi

J. Clin. Med. 2022, 11(18), 5264; https://doi.org/10.3390/jcm11185264 - 6 Sep 2022

Cited by 8 | Viewed by 1460

Abstract

Generally, weak muscle power is associated with high mortality. We aimed to evaluate the unknown association between % predicted value forced vital capacity (FVC% predicted) and mortality in asymptomatic older people, and the impact of muscle power on this association. We analyzed the Tsurugaya cohort that enrolled Japanese people aged ≥70 for 15 years with Cox proportional hazards model. Exposure variables were FVC% predicted and leg power. The outcome was all-cause mortality. The subjects were divided into quartiles by FVC% predicted or leg power, or into two groups by 80% for FVC% predicted or by the strongest 25% for leg power. Across 985 subjects, 262 died. The males with lower FVC% predicted exhibited higher mortality risks. The hazard ratio (HR) was 2.03 (95% CI 1.30–3.18) at the lowest relative to the highest groups. The addition of leg power reduced the HR to 1.78 (95% CI 1.12–2.80). In females, FVC% predicted under 80% was a risk factor and the HR was 1.67 (95% CI 1.05–2.64) without the effect of leg power. In FVC% predicted <80% males HRs were 2.44 (95% CI 1.48–4.02) in weak and 1.38 (95% CI 0.52–3.64) in strong leg power males, relative to ≥80% and strong leg power males. Low FVC% predicted was associated with high mortality with potential unfavorable effects of weak leg power in males. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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16 pages, 611 KiB

Open AccessArticle

A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults

by Yuki Yoshimatsu and David G. Smithard

J. Clin. Med. 2022, 11(17), 5214; https://doi.org/10.3390/jcm11175214 - 3 Sep 2022

Cited by 10 | Viewed by 6350

Abstract

In older adults, community-acquired pneumonia (CAP) is often aspiration-related. However, as aspiration pneumonia (AP) lacks clear diagnostic criteria, the reported prevalence and clinical management vary greatly. We investigated what clinical factors appeared to influence the diagnosis of AP and non-AP in a clinical setting and reconsidered a more clinically relevant approach. Medical records of patients aged ≥75 years admitted with CAP were reviewed retrospectively. A total of 803 patients (134 APs and 669 non-APs) were included. The AP group had significantly higher rates of frailty, had higher SARC-F scores, resided in institutions, had neurologic conditions, previous pneumonia diagnoses, known dysphagia, and were more likely to present with vomiting or coughing on food. Nil by mouth orders, speech therapist referrals, and broad-spectrum antibiotics were significantly more common, while computed tomography scans and blood cultures were rarely performed; alternative diagnoses, such as cancer and pulmonary embolism, were detected significantly less. AP is diagnosed more commonly in frail patients, while aspiration is the underlying aetiology in most types of pneumonia. A presumptive diagnosis of AP may deny patients necessary investigation and management. We suggest a paradigm shift in the way we approach older patients with CAP; rather than trying to differentiate AP and non-AP, it would be more clinically relevant to recognise all pneumonia as just pneumonia, and assess their swallowing functions, causative organisms, and investigate alternative diagnoses or underlying causes of dysphagia. This will enable appropriate clinical management. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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9 pages, 1588 KiB

Open AccessArticle

Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

by Lucía Méndez, Pedro Castro, Jorge Ferreira and Cátia Caneiras

J. Clin. Med. 2021, 10(23), 5593; https://doi.org/10.3390/jcm10235593 - 28 Nov 2021

Cited by 2 | Viewed by 2378

Abstract

Pneumonia is one of the main causes of hospitalization and mortality. It’s the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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Review

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14 pages, 1487 KiB

Open AccessReview

Comprehensive Approaches to Aspiration Pneumonia and Dysphagia in the Elderly on the Disease Time-Axis

by Takae Ebihara

J. Clin. Med. 2022, 11(18), 5323; https://doi.org/10.3390/jcm11185323 - 10 Sep 2022

Cited by 10 | Viewed by 5651

Abstract

Pneumonia in the elderly has been increasing on an annual basis. To a greater or lesser extent, aspiration is a major contributor to the development of pneumonia in the elderly. Antimicrobials alone are not sufficient for the treatment of pneumonia, and the condition may become intractable or even recur repeatedly. In addition, some patients with pneumonia may have no problems with eating, while others are unable to receive the necessary nutrition due to severe dysphagia. It has recently been found that pneumonia decreases both the muscle mass and strength of the swallowing and respiratory muscles, a condition named pneumonia-associated sarcopenia. This contributes to a pathophysiological time-axis of aspiration pneumonia and dysphagia in the elderly, in which silent aspiration leads to the development of pneumonia, and further to dysphagia, malnutrition, and low immunity. Therefore, it is recommended that the treatment and prevention of developing pneumonia should also differ according to an individual’s placement in the disease time-axis. In particular, approaches for preventing aspiration based on scientific findings are able to be implemented at home. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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12 pages, 604 KiB

Open AccessReview

Are Oropharyngeal Dysphagia Screening Tests Effective in Preventing Pneumonia?

by Ikuko Okuni and Satoru Ebihara

J. Clin. Med. 2022, 11(2), 370; https://doi.org/10.3390/jcm11020370 - 13 Jan 2022

Cited by 15 | Viewed by 4436

Abstract

Oropharyngeal dysphagia, a clinical condition that indicates difficulty in moving food and liquid from the oral cavity to the esophagus, has a markedly high prevalence in the elderly. The number of elderly people with oropharyngeal dysphagia is expected to increase due to the aging of the world’s population. Understanding the current situation of dysphagia screening is crucial when considering future countermeasures. We report findings from a literature review including citations on current objective dysphagia screening tests: the Water Swallowing Test, Mann Assessment of Swallowing Ability, and the Gugging Swallowing Screen. Pneumonia can be predicted using the results of the screening tests discussed in this review, and the response after the screening tests is important for prevention. In addition, although interdisciplinary team approaches prevent and reduce aspiration, optimal treatment is a challenging. Intervention studies with multiple factors focusing on the elderly are needed. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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18 pages, 5729 KiB

Open AccessReview

Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury

by Anja Maria Raab, Gabi Mueller, Simone Elsig, Simon C. Gandevia, Marcel Zwahlen, Maria T. E. Hopman and Roger Hilfiker

J. Clin. Med. 2022, 11(1), 211; https://doi.org/10.3390/jcm11010211 - 31 Dec 2021

Cited by 12 | Viewed by 3055

Abstract

Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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Other

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11 pages, 810 KiB

Open AccessSystematic Review

The Clinical Significance of Anaerobic Coverage in the Antibiotic Treatment of Aspiration Pneumonia: A Systematic Review and Meta-Analysis

by Yuki Yoshimatsu, Masaharu Aga, Kosaku Komiya, Shusaku Haranaga, Yuka Numata, Makoto Miki, Futoshi Higa, Kazuyoshi Senda and Shinji Teramoto

J. Clin. Med. 2023, 12(5), 1992; https://doi.org/10.3390/jcm12051992 - 2 Mar 2023

Cited by 11 | Viewed by 9855

Abstract

Introduction: Aspiration pneumonia is increasingly recognised as a common condition. While antibiotics covering anaerobes are thought to be necessary based on old studies reporting anaerobes as causative organisms, recent studies suggest that it may not necessarily benefit prognosis, or even be harmful. Clinical practice should be based on current data reflecting the shift in causative bacteria. The aim of this review was to investigate whether anaerobic coverage is recommended in the treatment of aspiration pneumonia. Methods: A systematic review and meta-analysis of studies comparing antibiotics with and without anaerobic coverage in the treatment of aspiration pneumonia was performed. The main outcome studied was mortality. Additional outcomes were resolution of pneumonia, development of resistant bacteria, length of stay, recurrence, and adverse effects. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: From an initial 2523 publications, one randomised control trial and two observational studies were selected. The studies did not show a clear benefit of anaerobic coverage. Upon meta-analysis, there was no benefit of anaerobic coverage in improving mortality (Odds ratio 1.23, 95% CI 0.67–2.25). Studies reporting resolution of pneumonia, length of hospital stay, recurrence of pneumonia, and adverse effects showed no benefit of anaerobic coverage. The development of resistant bacteria was not discussed in these studies. Conclusion: In the current review, there are insufficient data to assess the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia. Further studies are needed to determine which cases require anaerobic coverage, if any. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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