Poor Nutritional Status May Predict High Pneumonia Risk in Elderly, Study Finds

The prognosis was worse in patients with basic dementia or Alzheimers disease as well as chronic obstructive pulmonary disease or asthma.

A new study has found a correlation between poor nutritional status–related indexes and inflammatory indexes, further showing that poor nutritional status may predict a high risk of pneumonia in elderly adults.

Findings were published in Frontiers in Medicine.

The study authors noted that older age and comorbidities were risk factors for both the occurrence and poor prognosis of pneumonia, showing that comorbidities should be well treated in elderly (aged 65 and older) patients with pneumonia.

Two major types of pneumonia are hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP), and the study divided 669 patients into these groups, with 517 and 152 participants, respectively.

Among the patients, 72.65% were men and their mean (SD) age was 84.87 (8.49) years. Their mean age-adjusted Charlson Comorbidity Index (aCCI) score was 6.34 (1.97). Additionally, 42.60% received anti-infection treatment for 7 days or less, 28.91% for 8 to 14 days, 13.14% for 15 to 21 days, 5.81% for 22 days or more, and 9.54% until death.

The study found that infection outcome was negatively correlated with age in all patients (P = .013) and that level of albumin was negatively correlated with infection prognosis in all patients (P = .03). Albumin level was also negatively correlated with neutrophil count and C-reactive protein (CRP) (P = .008 and P < .001, respectively). ACCI was positively correlated with CRP (P = .003), and the prognosis was negatively associated with age and albumin level.

The prognosis was worse in patients with basic dementia or Alzheimer disease and chronic obstructive pulmonary disease (COPD) or asthma.

“In the HAP group, we selected myocardial infarction, albumin, chlorine, and chronic obstructive pulmonary disease as risk factors that collaboratively achieved an AUC [area under the curve] of 0.6219,” the authors said. “In the CAP group, we used calcium, chlorine, lymphocyte count, and myocardial infarction to calculate the total score, achieving an AUC of 0.6066.”

The study found no significant difference in sex, age, aCCI, or most underlying diseases between the HAP and CAP groups (P > 0.05). The authors also noted that nutritional status differed across regions.

“It was found that for both CAP and HAP patients, nutritional status was a risk factor for the occurrence and prognosis of pneumonia compared with other underlying diseases,” the authors said. “Common underlying diseases have an impact on nutrition, including diabetes, COPD, cerebrovascular disease, hemiplegia, dementia, peptic ulcer, moderately severe chronic kidney disease, liver disease.”

Myocardial infarction (P = .031) and COPD (P = .024) were both linked with a significantly higher risk of negative outcome, as well.

Cerebral infarction, cerebral hemorrhage, and other cerebrovascular diseases were also listed as underlying diseases that predispose elderly patients to pneumonia, in addition to left swallowing dysfunction. Esophageal tracheal fistula can also cause aspiration pneumonia—the most common type of pneumonia in elderly patients.

“In this study, the course of pneumonia was significantly prolonged in patients with COPD, dementia, cerebrovascular disease, and hemiplegia,” the authors said. “Similarly, tumor was also identified as a risk factor for pneumonia in the elderly patients. It may be due to the decline of immunity after the use of hormones, immunosuppressants, or chemotherapy.”

According to the authors, the Mini Nutritional Assessment Table (MNA) and Short Form MNA are both quick and reliable methods for assessing the nutritional status of patients 65 and older.

“Nutritional screening and targeted nutrition education should be carried out to reduce the incidence of poor nutritional status and pneumonia in the elderly,” they said.

Reference

Chen B, Liu W, Chen Y, et al. Effect of poor nutritional status and comorbidities on the occurrence and outcome of pneumonia in elderly adults. Front Med. Published online October 12, 2021. doi:10.3389/fmed.2021.719530