Pneumonia Hospitalization Rates On The Rise For Older Adults

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.

(JAMA.2005; 294:2712-2719. Available pre-embargo to the media at www.jamamedia.org)

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.

(JAMA.2005; 294:2760-2763. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For the financial disclosures of the authors, please see the JAMA editorial.