Interventions to Prevent Pneumonia Among Older Adults

• Published in: Journal of the American Geriatrics Society (JAGS) 2001-01, Vol.49 (1), p.85-90
• Main Authors: Yamaya, Mutsuo, Yanai, Masaru, Ohrui, Takashi, Arai, Hiroyuki, Sasaki, Hidetada
• Format: Article
• Language: English
• Subjects: Aged; Amantadine - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; cerebrovascular disease; Cerebrovascular Disorders - prevention & control; dopamine; Drug therapy; Elderly people; Gastroesophageal Reflux - prevention & control; Human bacterial diseases; Humans; Infection Control; Infectious diseases; Influenza Vaccines - administration & dosage; Influenza, Human - prevention & control; Levodopa - therapeutic use; Medical sciences; Miscellaneous; Older people; oral care; Oral Hygiene; Pneumococcal Vaccines - administration & dosage; Pneumonia; Pneumonia - etiology; Pneumonia - prevention & control; Pneumonia, Aspiration - etiology; Pneumonia, Aspiration - prevention & control; Prevention and actions; Preventive health care; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; silent aspiration; substance P; Substance P - antagonists & inhibitors
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2001.49015.x

Pneumonia is a common cause of death in older people. Antimicrobial drugs do not prevent pneumonia and, because of increasingly resistant organisms, their value in curing infection will become more limited. Establishing new strategies to prevent pneumonia through consideration of the mechanisms of this devastating illness is essential. The purpose of this review is to discuss how pneumonia develops in older people and to suggest preventive strategies that may reduce the incidence of pneumonia among older adults. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia; impairments in swallowing and cough reflexes among older adults, e.g., related to cerebrovascular disease, increase the risk for the development of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. For example, since both swallowing and cough reflexes are mediated by endogenous substance P, pharmacologic therapy using angiotensin‐converting enzyme inhibitors, which decrease substance P catabolism, may improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine (and, of course, prevention of cerebral vascular disease, which can result in basal ganglia strokes) should affect the incidence of pneumonia. The purpose of this review is to consider promising pharmacologic treatments as methods of preventing pneumonia in older adults and to review other proven strategies, e.g., infection control and cerebrovascular disease prevention that will lessen the incidence of pneumonia.