Predicting Pneumonia Risk in Older Adults

Study results published in the July 2016 issue of the Journal of the American Geriatrics Society indicated that data commonly available in electronic medical records (EMRs) can help clinicians determine which older adults may be most at risk for pneumonia. The researchers who conducted the study developed a prediction score using this data to stratify older adults into groups with varying subsequent 2-year pneumonia risk.

The study findings may help battle this leading cause of sickness and mortality among older adults. Indeed, approximately 40% of older adults with pneumonia are hospitalized and experience high complication and mortality rates.

Age, chronic lung disease, smoking, being underweight, and having difficulty functioning are known to be risk factors for pneumonia. Michael L. Jackson, PhD, MPH, an Associate Investigator at the Group Health Research Institute in Seattle, and colleagues from the University of California at San Francisco and University of Washington sought to develop three prognostic indices of varying degree of required detail for 2-year pneumonia risk in older adults.

In order to determine their prediction score the research team studied 3,392 community-dwelling, dementia-free individuals aged 65 and older (59% female) who had been members of Group Health, an integrated healthcare delivery system in the Seattle area, for at least 2 years at baseline and who were enrolled in the Adult Changes in Thought (ACT) study.

Potential risk factors for pneumonia were identified from questionnaire data and interviewer assessments of functional status, medical history, smoking and alcohol use, cognitive function, personal care, and problem solving. Physical measures such as grip strength and gait speed were also used to identify risk factors, as was administrative database information on comorbid illnesses, laboratory tests, and prescriptions dispensed. Incident community-acquired pneumonia was defined presumptively from administrative data and validated using medical record review. Nearly 3,000 visits were utilized to identify and assess all risk factors.

During follow-up, 642 pneumonia events were observed by the researchers. Of these patients, 574 died. Dr. Jackson and colleagues identified the following six factors as being critical predictors in all prognostic indices:

• Age
• Gender
• Chronic obstructive pulmonary disease
• Congestive heart failure
• BMI
• Use of inhaled or oral corticosteroids

“A risk score based on these variables, information on which is commonly available in [EMRs], had equal or better performance… than scores including more-detailed data such as functional status,” wrote Dr. Jackson, et al. The researchers said clinicians could possibly use the pneumonia prediction score to encourage older adults to receive the pneumococcal vaccine that protects against pneumonia and to counsel at-risk patients about positive behavioral changes, including quitting smoking.