Yoshimatsu, Yuki, Heledd, Thomas, Thompson, Trevor ORCID: https://orcid.org/0000-0001-9880-782X and Smithard, David G (2024) Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty? European Geriatric Medicine. pp. 1-8. ISSN 1878-7649 (Print), 1878-7657 (Online) (doi:10.1007/s41999-023-00929-0)

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Abstract

Purpose Little is known about the long-term and functional prognoses of older adults with pneumonia, which complicates
their management. There is a common belief that aspiration is a poor prognostic factor; however, the diagnosis of aspiration
pneumonia (AP) lacks consensus criteria and is mainly based on clinical characteristics typical of the frailty syndrome.
Therefore, the poor prognosis of AP may also be a result of frailty rather than aspiration. This study investigated the impact
of AP and other prognostic factors in older patients with pneumonia.
Methods We performed a retrospective cohort study of patients aged 75 years and older, admitted with pneumonia in 2021.
We divided patients according to their initial diagnosis (AP or non-AP), compared outcomes using Kaplan–Meier curves,
and used logistic regression to identify independent prognostic factors.
Results 803 patients were included, with a median age of 84 years and 52.7% were male. 17.3% were initially diagnosed with AP.
Mortality was significantly higher in those diagnosed with AP than non-AP during admission (27.6% vs 19.0%, p = 0.024) and
at 1 year (64.2% vs 53.1%, p = 0.018), with survival analysis showing a median survival time of 62 days and 274 days in AP and
non-AP, respectively (χ2 = 9.2, p = 0.002). However, the initial diagnosis of AP was not an independent risk factor for poor prognosis
in multivariable analysis. Old age, frailty and cardio-respiratory comorbidities were the main factors associated with death.
Conclusion The greater mortality in AP may be a result of increased frailty rather than the diagnosis of aspiration itself.
This supports our proposal for a paradigm shift from making predictions based on the potentially futile labelling of AP or
non-AP, to considering frailty and overall condition of the patient.

Item Type:	Article
Uncontrolled Keywords:	dysphagia; aspiration pneumonia; CAP; frailty; anticholinergic
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > R Medicine (General) R Medicine > RB Pathology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Exercise Activity and Rehabilitation
Last Modified:	12 Mar 2024 12:40
URI:	http://gala.gre.ac.uk/id/eprint/46235

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