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Pneumonia in Elderly Increasing Rapidly Says
Hospital Study
Rates for seniors age 65 to 84 show 20 percent
increase over 15 years
Dec. 8, 2005 - Hospitalization rates for pneumonia
have increased substantially for U.S. adults 65 to 84 years of age,
according to a study in the December 7 issue of JAMA. And, an in an
editorial, the authors say new strategies for preventive vaccines are
necessary. (See editorial below story). This reports seems to challenge
an earlier study in the magazine that found that the incidence of
invasive pneumococcal disease among adults aged 50 years or older
declined 28 percent, from 40.8 cases/100,000 in 1998-1999 to 29.4 in
2002-2003 (see sidebar link).
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Pneumonia Vaccine Information Statement
(pdf) From
the CDC. What you need to know! |
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Pneumonia is among the top 10 causes of death in
the United States and is a significant cause of outpatient visits and
hospitalizations, according to background information in the article.
Factors that increase the risk for pneumonia include the presence of
underlying medical conditions, advanced age, functional disability, and
residency in long-term care facilities.
Alicia M. Fry, M.D., M.P.H., of the Centers for
Disease Control and Prevention, Atlanta, and colleagues conducted a
study to determine if an increase in chronic underlying conditions might
be contributing to greater hospitalization rates for pneumonia.
The researchers used data from the National
Hospital Discharge Survey (NHDS) to study trends according to age groups
in hospitalization rates for pneumonia during a 15-year period
(1988-2002) among U.S. residents aged 65 years or older.
The characteristics, outcomes, and comorbid
(co-existing illness) disease diagnoses of patients with a hospital
discharge diagnosis of pneumonia were compared with those of patients
with a hospital discharge diagnosis for other causes during the study
period.
The researchers found that hospitalization rates
for pneumonia increased by 20 percent from 1988-1990 to 2000-2002 for
patients aged 65 to 74 years and for patients aged 75 to 84 years.
Rates of hospitalization for pneumonia were 2-fold
higher for patients aged 85 years or older (51 per 1,000 population for
first-listed discharge code of pneumonia) than among patients aged 75 to
84 years but did not significantly increase from 1988-1990 to 2000-2002.
The proportion of patients aged 65 years or older
diagnosed with pneumonia and a chronic cardiac disease, chronic
pulmonary disease, or diabetes mellitus increased from 66 percent in
1988-1990 to 77 percent in 2000-2002.
During 2000-2002, approximately 1 in 83 patients
aged 65 to 74 years and 1 in 38 patients aged 74 to 84 years were
hospitalized each year with a first-listed diagnosis of pneumonia.
The increasing proportion of patients with
underlying comorbid conditions among those hospitalized for pneumonia
supports our primary hypothesis that an increase in the prevalence of
underlying conditions that predispose individuals to pneumonia might
partially account for the increase in rates of pneumonia hospitalization
among patients aged 65 to 84 years.
Our findings suggest that efforts to prevent
pneumonia among older adults should focus on those at the extremes of
age and those with underlying medical conditions, the authors write.
because the number of individuals at highest
risk for pneumonia, those aged 85 years or older, will continue to
increase in the United States and behavioral changes may be difficult to
sustain, additional strategies, such as more effective vaccines for
older individuals and new vaccines for common pathogens without a
currently licensed vaccine
will likely be necessary, they write.
Editorial: Pneumonia In Older Adults Reversing
The Trend
In an accompanying editorial, Thomas M. File, Jr.,
M.D., and James S. Tan, M.D., of Northeastern Ohio Universities College
of Medicine, Rootstown, Ohio, and Summa Health System, Akron, Ohio,
comment on the study on pneumonia and older adults.
As Fry et al point out, new strategies for
preventive vaccines are necessary. The development of more potent
vaccines could potentially further reduce complications in elderly
persons. It will be important to determine whether new recommendations
for influenza vaccination of children will have a similar effect of
reducing the disease burden in older adults as it has with the use of
the conjugate pneumococcal vaccine for invasive pneumococcal disease.
Chemoprophylaxis can be used as an adjunct to
vaccination for prevention and control of influenza. Chemoprophylaxis
may be useful for those who have household exposure to influenza, who
live or work in institutions with an influenza outbreak, or who are at
high risk for influenza complications in the setting of a community
outbreak. Chemoprophylaxis also may be useful for persons with
contraindications to influenza vaccine or as an adjunct to vaccination
for those who may not respond well to influenza vaccine (e.g., persons
with human immunodeficiency virus), the authors write.
Clinicians can intervene to modify some of the
associated risk factors for pneumonia in older adults. Administration of
preventive vaccines, counseling about smoking cessation, stabilization
of underlying conditions, and promotion of appropriate nutrition may
help to reduce the risk of community-acquired pneumonia and thereby
promote longer and healthier lives for older adults, the authors
conclude.
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