Bacterial Pneumonia in Older Adults

Henig, Oryan; Kaye, Keith S.

doi:10.1016/j.idc.2017.07.015

Cited by 109 publications

(87 citation statements)

References 145 publications

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“…Disrupted response pathways during pertussis, measles, influenza A, and hepatitis B would be particularly acute in children and adolescents [54][55][56][57], who as a population can experience offlabel use of antipsychotics in the treatment of ADHD. Disruption in the responses to legionellosis, influenza A, and Staphylococcus aureus infection, all of which are significant causes of morbidity and mortality in nursing home residents [58][59][60], are also predictable. Off-label antipsychotic drug use in nursing homes has been reported to be as high as 37% of patients (with and without dementia) [61].…”

Section: Fig 5 Immune Dysregulation and Infectious Disease Susceptibmentioning

confidence: 99%

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

et al. 2019

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Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it's active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly.

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Section: Fig 5 Immune Dysregulation and Infectious Disease Susceptibmentioning

confidence: 99%

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

et al. 2019

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“…Many factors related to aging, such as comorbidities, nutritional status, and swallowing dysfunction have been found to increase the incidence of pneumonia in the older population [12]. Additionally, Jackson et al [9] reported an increase of incidence of pneumonia in older male populations and smokers.…”

Section: Introductionmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

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The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.

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“…The reported incidence of infections was higher in the older adult population because of the presence of chronic comorbidities, deteriorating organ functions and reduced host defence system [15,16]. Older adults also have poorer outcomes as a consequence of infections, including higher mortality, compared to adults of other age groups [17].…”

Section: Introductionmentioning

confidence: 99%

“…Older adults also have poorer outcomes as a consequence of infections, including higher mortality, compared to adults of other age groups [17]. Atypical clinical presentations of infections, undertreatment or overtreatment, high risk of multidrug-resistant organism acquisition, rapid disease progression and prolonged recovery all contribute to poorer outcomes in the elderly [15,16]. Moreover, older adults who were living alone have lower health literacy and hence lower self-management abilities, contributing to poorer health [16,18,19].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

et al. 2019

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Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

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Bacterial Pneumonia in Older Adults

Cited by 109 publications

References 145 publications

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

Psychotropic Drug-Associated Pneumonia in Older Adults

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

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