Association between sarcopenia and pneumonia in older people

Abstract

Pneumonia is a major cause of death in older people, and the number of such deaths is increasing. Present guidelines for pneumonia management are based on a pathogen‐oriented strategy that relies on the optimal application of antibiotics. Older pneumonia inpatients show the high incidence of aspiration pneumonia. The main cause of aspiration pneumonia is an impairment in the swallowing and cough reflexes. These facts suggest a limitation of present management strategies and a requirement for new strategies for aspiration pneumonia. Sarcopenia is the loss of muscle strength and mass, and declining physical function with aging. Recently, a decrease in the mass or strength of the swallowing muscles was suggested to be associated with reduced swallowing function. Accordingly, dysphagia caused by sarcopenia of the systemic and swallowing‐related muscles was named sarcopenic dysphagia. Presently, few studies have shown associations between aspiration pneumonia and sarcopenic dysphagia. As for the cough reflex, strong cough prevents aspiration pneumonia, and its strength is regulated by respiratory muscles. A few studies have reported a relationship between muscles and pneumonia in older people. Sarcopenia is a risk factor for pneumonia in older people, and aspiration pneumonia inpatients with low muscle mass show high mortality rates. Aspiration pneumonia induced muscle atrophy in respiratory, swallowing, and skeletal muscles in an animal model and humans. Associations between respiratory muscle strength and pneumonia are currently under investigation. Evaluation and management of sarcopenia could potentially become a new strategy to prevent and treat pneumonia in older patients, and research has only recently been launched. Geriatr Gerontol Int 2020; 20: 7–13.

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

“…undernutrition [4][5][6]. In the complex geriatric context, Okazaki and colleagues (2019) recently presented the concept of "vicious circle of aspiration pneumonia" where sarcopenia, undernutrition, and inflammation are at the core of recurrent aspiration pneumonia [7]. Sarcopenia is recognized as a syndrome characterized by a progressive and generalized loss of skeletal muscle mass and strength, with a risk of adverse outcomes, such as physical disability, poor quality of life and death [8].…”

Risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients: a retrospective study in Japan

“…Introduction C ommunity and hospital acquired pneumonia is still one of the major lethal causes in Japan, especially in aged generations, (1)(2)(3)(4)(5)(6)(7) whereas several preventive medical practices including vaccination for pneumonia have been performed. (8)(9)(10) In aged populations, majority of community acquired pneumonia might be caused by aspiration and/or dysphagia, which might lead to a high recurrence rate and poor prognosis of the disease.…”

Skeletal Muscle Area Is an Independent Predictor for Mortality in Elderly Patients With ANCA Associated Vasculitis

“…Studies have shown that skeletal muscle mass is a predictor of mortality in ICU patients and patients with aspiration pneumonia [18]. A decrease in muscle mass and strength especially in swallowing related muscles may affect the prognosis of pneumonia in older patients [19]. The majority of infections in our study were pneumonia and the most deaths were due to infections.…”