May 9, 2022

Study Reveals Critical Differences in Older Geriatric Patients with Community-Acquired Pneumonia

Clinicians examine strategies to address unique needs of those aged 85 and older

22-GER-2862352-CQD-Hero-650×450-1

A multi-institutional study led by Cleveland Clinic experts revealed that patients with community-acquired pneumonia who are aged 85 and older have different comorbidities and disease etiologies than those who are between the ages of 65 and 75. According to findings recently published in theJournal of Investigative Medicine, this older patient population also receives less-intensive treatment and has a higher mortality rate.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Building off of previous research, investigators set out to better understand this particularly vulnerable population. “We thought it would be interesting to evaluate how we treat the oldest geriatric patients, in whom clinical research is limited,” explains internist Michael B. Rothberg, MD, study coauthor and Vice Chair for Research in Cleveland Clinic’s Medicine Institute. “In most cases, ‘older’ patients are defined as over the age of 65; however, being 65 has very different implications than being 85. We wanted to examine how the care and outcomes of patients in the very elderly group differ from the experiences of those who are one or two decades younger.”

Study methods and findings

Demographic data from the retrospective cohort study revealed that patients 85 years and older were more likely to be white, female, and admitted with aspiration pneumonia. Additionally, the researchers observed that this older cohort suffered from higher rates of dementia but lower rates of diabetes and chronic obstructive pulmonary disease.

Data showed that Staphylococcus aureus was the most common pathogen across all age groups (33.4%); however, patients 85 years and older were more likely to have Escherichia coli pneumonia when compared with those ages 65 to 74 years (16.1% vs. 10.7%).

Although older patients in the study had a greater in-hospital mortality, Dr. Rothberg notes that they were also less likely to be admitted to the ICU and receive mechanical ventilation than their younger counterparts.

Advertisement

Rates of acute kidney injury and Clostridium difficile infections were also lower in the 85 and older age group. Additionally, data demonstrated that these patients had shorter lengths of stay and fewer medical costs, and were more likely to be discharged to a skilled nursing facility or hospice.

“These findings suggest that the care these older patients received was, on average, less intense than the care provided to their younger counterparts,” explains Dr. Rothberg. “Interestingly, the older the patient, the more pronounced this discrepancy. This raises critical questions and emphasizes the need to understand the driving force behind this trend. The data may indicate that older patients are potentially being under treated. On the other hand, older patients may be declining more aggressive care because they recognize the risks posed by their comorbidities.”

Ongoing research

To better understand this patient population, Dr. Rothberg and his team are currently working on a follow-up study that examines do-not-resuscitate orders and the effect they have on the treatment and outcomes of geriatric patients.

“Advanced directives are essential, especially in patients with pneumonia, who typically present with a number of comorbidities. It is important we handle these cases with sensitivity. The oldest and sickest patients are regularly faced with life-and-death decisions, so they warrant careful consideration,” he adds, noting that doctors are seldom trained to have difficult end-of-life conversations.

Advertisement

“This is an opportunity to develop the tools necessary to help patients and families navigate these difficult issues,” Dr. Rothberg concludes.

Related Articles

23-GER-4067514-CQD-Hero-650×450-1
October 11, 2023
Electronic Medical Records May Be Key to Diagnosing Delirium in Geriatric Emergency Patients

Structured data helps identify older adults at risk for poor outcomes, defines patients who require more comprehensive assessments

Telemedicine doctors and patients
January 18, 2023
Virtual Capacity Evaluations May Provide Distinct Safeguards for Geriatric Patients

Analysis underscores how telehealth can help pinpoint elder abuse

22-MED-3347258-CQD-Hero-650×450-1
December 29, 2022
Digital Dashboard Addresses Gaps, Improves Care of Geriatric Patients With Delirium

Accurate, transparent documentation may reduce risks associated with common disorder

22-GER-3018903-CQD-Hero-650×450-1
August 25, 2022
Gun Ownership and Medical Marijuana: Unexpected Barriers to Certain Treatments for Chronic Pain

Clinicians face difficult conversations when drugs and firearms intersect

22-GER-3020214-CQD-Hero-650×450-1
July 15, 2022
Speech and Swallowing Issues Often Overlooked in Geriatric Patients Despite Taking a Heavy Toll

New study confirms prevalence, downstream effects of dysphagia and dysphonia

22-GER-3020219-CQD-Hero-650×450-1
July 5, 2022
Staff Education Improves Fidelity of Dementia Screening and Early Intervention

Accuracy of Mini-Cog screening tool enhanced by mandatory training

19-HRT-3906-Low-Dose-Aspirin-CQD
February 9, 2022
1-Minute Consult: Should My Older Adult Patients Take Aspirin for the Primary Prevention of Cardiovascular Disease?

Experts examine the dangers and potential benefits of aspirin in geriatric patients

21-GER-2519065-CQD-Hero-1-650×450
December 20, 2021
Major Award from NIA and Related Dementia Research Viewed Through Geriatric Prism

Research led by Cleveland Alzheimer's Disease Center could foster collaboration and help identify novel therapies

Ad