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      Risk factors and interventions for developing recurrent pneumonia in older adults

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          Abstract

          Background

          Pneumonia is common among older adults and often recurrent. Several studies have been conducted on the risk factors for pneumonia; however, little is known about the risk factors for recurrent pneumonia. This study aimed to identify the risk factors for developing recurrent pneumonia among older adults and to investigate methods of prevention.

          Methods

          We analysed the data of 256 patients aged 75 years or older who were admitted for pneumonia between June 2014 and May 2017. Moreover, we reviewed the medical records for the subsequent 3 years and defined the readmission caused by pneumonia as recurrent pneumonia. Risk factors for recurrent pneumonia were analysed using multivariable logistic regression analysis. Differences in the recurrence rate based on the types and use of hypnotics were also evaluated.

          Results

          Of the 256 patients, 90 (35.2%) experienced recurrent pneumonia. A low body mass index (OR: 0.91; 95% CI: 0.83‒0.99), history of pneumonia (OR: 2.71; 95% CI: 1.23‒6.13), lung disease as a comorbidity (OR: 4.73; 95% CI: 2.13‒11.60), taking hypnotics (OR: 2.16; 95% CI: 1.18‒4.01) and taking histamine-1 receptor antagonist (H1RA) (OR: 2.38; 95% CI: 1.07‒5.39) were risk factors. Patients taking benzodiazepine as hypnotics were more likely to experience recurrent pneumonia than patients not taking hypnotics (OR: 2.29; 95% CI: 1.25–4.18).

          Conclusion

          We identified several risk factors for recurrent pneumonia. Among them, restricting the use of H1RA and hypnotics, in particular benzodiazepines, may be useful in preventing the recurrence of pneumonia in adults aged 75 years or older.

          Abstract

          Methods for preventing recurrent pneumonia in older adults are limited. This study shows that avoiding the use of benzodiazepine hypnotics and histamine 1 receptor antagonists could help prevent recurrence of pneumonia in adults aged ≥75 years. https://bit.ly/403Nsuu

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          Most cited references39

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          American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

          (2019)
          The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.
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            BTS guidelines for the management of community acquired pneumonia in adults: update 2009.

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              Oral care reduces pneumonia in older patients in nursing homes.

              Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people. Survey. Eleven nursing homes in Japan. Four hundred seventeen patients randomly assigned to an oral care group or a no oral care group. Nurses or caregivers cleaned the patients' teeth by toothbrush after each meal. Swabbing with povidone iodine was additionally used in some cases. Dentists or dental hygienists provided professional care once a week. Pneumonia, febrile days, death from pneumonia, activities of daily living, and cognitive functions. During follow-up, pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care. Oral care was beneficial in edentate and dentate patients. Activities of daily living and cognitive functions showed a tendency to improve with oral care. We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes.
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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                July 2023
                02 May 2023
                : 9
                : 3
                : 00516-2022
                Affiliations
                [1 ]Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, Tokyo, Japan
                [2 ]Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
                [3 ]Centre for Preventive Medicine, Nomura Hospital, Tokyo, Japan
                [4 ]Department of Respiratory Medicine, Toranomon Hospital (Branch), Kanagawa, Japan
                Author notes
                Corresponding author: Atsushi Miyamoto ( atsushimotty@ 123456gmail.com )
                Author information
                https://orcid.org/0000-0002-3444-0536
                Article
                00516-2022
                10.1183/23120541.00516-2022
                10152262
                37143835
                c4b9cb58-4d5b-4f1b-a1c6-a87d28cb2a03
                Copyright ©The authors 2023

                This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

                History
                : 04 October 2022
                : 14 March 2023
                Categories
                Original Research Articles
                Respiratory Infections
                4

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