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. 2024 Apr;15(2):481-488.
doi: 10.1007/s41999-023-00929-0. Epub 2024 Feb 3.

Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty?

Yuki Yoshimatsu  1   2   3 , Heledd Thomas  4 , Trevor Thompson  5 , David G Smithard  4   6
Affiliations

Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty?

Yuki Yoshimatsu et al. Eur Geriatr Med. 2024 Apr.

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.

Keywords: Anticholinergic; Aspiration pneumonia; CAP; Dysphagia; Frailty.

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Conflict of interest statement

The corresponding author is supported by The Japanese Respiratory Society Fellowship Grant. The sponsor had no role in this study design, review process, writing of the manuscript, or decision to publish. The authors received no other financial support for the research, authorship and publication of this article. The authors declare that they have no other competing interests.

Figures

Fig. 1
Fig. 1
Survival curve according to initial diagnosis. The median time to death was 62 days in the AP group and 274 days in the non-AP group, with most deaths occurring in the first few weeks after admission
Fig. 2
Fig. 2
Causes of death according to the timing of death. The most common causes of death in hospital were pneumonia and cardiologic conditions, whereas for death after initial discharge, although pneumonia was still the most common cause of death recorded, there were more cancers and frailty than cardiologic causes
See this image and copyright information in PMC

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