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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to evaluate the prognostic importance of the conditions before abdominal surgery for patients over 60 years of age. Multivariate analyses of postoperative complications were performed in 634 patients (comprising 525 cases of elective abdominal surgery and 109 cases of emergency abdominal surgery). The Mortality rate was significantly higher (p < 0.01) in the emergency group (11.9%) and relatively low among the elective abdominal surgery group (3.8%). In the emergency group, 13 patients died, and MOF (multiple organ failure) was found to be the direct cause of death in 11 (85%). Although, the majority (75%) of emergency operations were for benign disorders, the remainder (25%) had malignant tumors. It is noteworthy that among 25% of cases, obstructions and perforations due to large bowel cancers were found to be 59% and 19%, respectively. In the elective surgery group, postoperative pulmonary and cardiovascular complications were found in 11.6% and 9.6%, respectively. Death due to cardiovascular problems in rare (5%), however, postoperative pneumonia was the cause of death in 70% of all of postoperative death. Risk factors affecting postoperative pulmonary complications were malnutrition, advanced age, male sex, malignant disease, dementia, cerebrovascular disorders, impaired pulmonary function tests. Surprisingly, the risk factors were identical, except for impaired pulmonary function, for postoperative MRSA pneumonia. In our study, postoperative pulmonary death was not associated with impaired pulmonary function, and it appears to be rather affected by the presence of cerebrovascular disorders and malnutritional state. A poor nutritional states (< 40 according to Onodera's nutritional index) was present in over 50% of patients with cerbrovascular disorders and low ADL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognostic analysis for postoperative complications of abdominal surgery in the elderly]. 143 58

The medical records and autopsy data of patients over the age of 70 years at death with a diagnosis of intracerebral hemorrhage (ICH) in the Yokufukai Geriatric Hospital were reviewed. All cases with ICH caused by head injury, rupture aneurysms or arteriovenous malformations were excluded from this study. There were 73 autopsied cases with spontaneous ICH from January 1978 to September 1988. There were 33 men and 40 women. Fourteen percent of the patients had a stroke while hospitalized for another disorder. Their ages at death ranged from 70 to 99 years with a mean of 81.8 years. Of these, 48 cases (66%) were 70 years or older at the time of ICH. In the senile ICH (over 70 years), the following characteristics were observed; (1) the most common location was the thalamus, which accounted for 33.3% of the hemorrhage. (2) subcortical and cerebellar hemorrhage accounted for 16.6% and 14.6% of the total, respectively. (3) there was no pontine hemorrhage. Fifty-seven percent had anamnestic hypertension before the stroke. The ages at which they became bedridden state ranged from 62 to 92 years with a mean of 79.5 years. This study revealed that the non-organic factors such as insidious generalized muscular weakness or decreased spontaneity were important as causes of the deterioration of ADL in the chronic stage of the senile ICH. Within one year after becoming bedridden state, 76.1% of all patients died. The bedridden state in the elderly with the residuals of ICH indicated a poor prognosis. As causes of death, pneumonia occurred in 28.8% of all patients, brain death in 19.2%, and sudden death in 12.3%.
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PMID:[Cerebrovascular disease in the elderly--a clinicopathological study of 73 autopsied cases with intracerebral hemorrhage]. 236 29

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

To clarify the characteristic features of nursing home-acquired pneumonia in our community hospital, we performed a clinical analysis of 86 patients with nursing home-acquired pneumonia. The patients were divided into young and elderly groups. In the young group cerebral palsy was the underlying disease. In the elderly group, it was cerebrovascular attack. Although there were no differences in ADL, the nutritional condition of the young group was comparatively good, the isolated microorganism consisted of mostly Mycoplasma pneumoniae and the prognosis was good. The elderly group where the nutritional condition was poor, the patients were detected by non-respiratory symptoms and risk factors such as obvious episodes of aspiration led us to be concerned about the risk factors for nursing home-acquired pneumonia. The microorganism isolated from the sputum of the elderly group was frequently a multi-drug resistant microorganism such as Methicillin-resistant Staphylococcus aureus (MRSA) and polymicrobial infection. Their prognosis was poor despite treatment with multiple antibiotics. In the comparative study between survivors and non-survivors in the elderly group, risk factors such as hypotension, consciousness disturbance, the extension of infiltration shadows, respiratory failure, multiple organ failure and metabolic acidosis were influenced for the prognosis, but the isolated microorganisms and the antimicrobial agents were not concerned.
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PMID:[Clinical analysis of nursing home-acquired pneumonia in a community hospital]. 1083 38

To estimate the usefulness of the bedside swallowing assessment proposed by Smithard et al and neuroimaging findings characteristic for dysphagia, we studied the outcome of 102 patients with chronic cerebral infarction after assessment of swallowing by this test with brain computerized tomography (CT). All patients had a variety of motor disturbance and were admitted on a long-term medicare basis. They were divided into two groups according to the findings: the positive group (n = 33), who showed any of the listed types of difficulty in swallowing water, and the negative group (n = 69). Followed up to 2.2 years, their outcomes were studied. CT findings were studied on type of infarction, number and laterality of infarction, grade of periventricular lucency (PVL), presence of ventricular dilatation (VD), and severity of cortical atrophy (CA). The mean age was 76.4 years at registration and 61 were men. The frequency of severe dementia and disturbed ADL were significantly higher in the positive group. Eighteen patients died during the observation period and 15 of those were in the positive group, indicating higher annual death rate (29.9% vs 2.2% in the negative group). All of the 15 patients in the positive group died of pneumonia. CT findings showed high incidence of multiple infarction, bilateral hemispheric lesion, severe PVL, VD, and severe CA in the positive group. These findings indicated that this evaluation method was useful in screening swallow function for patients with cerebral infarction in the chronic phase. Furthermore, CT findings suggested that severe white matter lesion, VD, and severe CA as well as multiple infarction seen in bilateral hemisphere was related to dysphagia, probably due to multiple factors involving pyramidal- and extrapyramidal-tracts with higher brain function.
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PMID:[Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome]. 1160 14

Pneumonia has been estimated to be the second most common infection in nursing-home residents. However, to the authors' knowledge, no such Swedish data are available. Therefore, this study investigated the incidence, risk factors, and 30 d case-fatality rate and clinical presentation of nursing home-acquired pneumonia (NHAP) in 234 nursing-home residents aged 66-99 y. Activities of daily living (ADL status), malnutrition and body mass index were measured at baseline. The residents were then followed prospectively during 1 y for symptoms and signs of pneumonia. Pneumonia was verified clinically and/or radiologically in 32 residents, corresponding to a yearly incidence of 13.7%. The 30 d case-fatality rate was 28%. Cough and sputum production were the most specific, and fever > or = 38.0 degrees C rectally and cognitive decline were the most common non-specific presenting symptoms. Chronic obstructive pulmonary disease, ADL status > 5 and male gender were risk factors for acquiring pneumonia. In conclusion, NHAP is associated with high morbidity and mortality in Sweden. In order not to delay treatment, it is necessary to be aware that specific symptoms of pneumonia may be lacking in the clinical presentation in the nursing-home setting.
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PMID:Morbidity, mortality and clinical presentation of nursing home-acquired pneumonia in a Swedish population. 1287 15

Pneumonia is a common cause of death in elderly people. A series of our studies have demonstrated that pneumonia in the elderly is characterized by silent aspiration, impaired swallowing and cough reflex, partly due to cerebral infarctions at basal ganglia. These infarctions probably induce the disruption of the specific central neurotransmitter system including dopamine and substance P, which plays an important role for swallowing and cough reflex. Use of ACE inhibitor and stimulation of the oral cavity by simple oral care, which are effective in increasing substance P. reduced the incidence of aspiration pneumonia. Moreover, use of a dopamine agonist such as amantadine hydrochloride and a folic acid supplement that are known to potentiate dopaminergic neurons also prevented aspiration pneumonia. For patients bedridden due to lowered ADL, it is essential for them to keep an upright position a few hours after meals to prevent aspiration pneumonia caused by the reflux of ingested foods. Also, administration of neuroleptics may cause aspiration pneumonia by suppression of dopaminergic neurons.
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PMID:[Cerebrovascular disease and pneumonia in the elderly]. 1293 58

As the growth of elderly population increases, the number of geriatric patients who may demand health care services is also increasing since the elderly are more vulnerable to various conditions of acute illnesses. Upper respiratory tract infections are the leading cause of death and the most significant cause that impairs quality of life in the elderly. Upper respiratory tract infections and influenza are common in the elderly and may develop into pneumonia. Considering the high morbidity and mortality rates related to pneumonia in the elderly, it is important to have prevention strategies. A delay in diagnosis due to non-specific signs and symptoms of pneumonia in the elderly has demanded greater concern on the importance of pneumonia prevention strategies. Influenza and pneumonia impair quality of life in the elderly, resulted in decreased functional status (ADL scores) during infection and recovery period. With increasing antibiotic resistance, the management may be complicated as it may lead to conditions that reduce quality of life and cause high mortality rate. Therefore, immunization is very important as the prevention strategy against influenza and or pneumonia, reducing the incidence as well as the complication. The consensus has been made in order to provide immunization against influenza and pneumonia for elderly population in Indonesia. It is expected that by 2025, about 60% of the elderly in Indonesia would have immunization against influenza and 50% of them would have immunization against pneumonia annually.
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PMID:National consensus on geriatric immunization 2011. 2245 Nov 91

Frailty comes from decline of functions in multi-organs, not a single organ dysfunction (disease). This accounts for comorbidity in the elderly, both in the acute and chronic ill conditions. In the Kyorin University Hospital, which have a role of emergency hospitals in the western area of Tokyo, more than seventy percent of the patients admitted to the geriatric ward are emergent cases. They have multi-diseases; the most frequent one is pneumonia(from aspiration). Often, their ADL is poor and have cognitive disorders, which is why they stay in the ward long. Geriatric syndrome indicates signs and symptoms frequently observed in the elderly. Because geriatric syndromes stem from multi-system dysfunction, they cannot be treated well enough. However, if geriatric syndromes are left untreated, the ADL declines in a steady state. Usually, geriatric syndromes cannot be treated by medication, but well-planned care can prevent progression. From this sense, not a medicine but multidisciplinary approach, such as cooperation with nurse, dietitian, PT, OT, pharmacist, social worker, care programmer and others, is the key to preventing elderly people from failing to the disabled state.
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PMID:[Frailty and geriatric syndrome]. 2385 98

Despite the development of strong antibiotics, the pneumonia death is increasing all over the world in these decades. Among the people who died of pneumonia, the majority were 65 years old or over. Although pneumonia is recently categorized into several entities, aspiration pneumonia includes all entities. Therefore, targeting dysphagia and aspiration to treat pneumonia is a promising strategy and anti-aspiration drugs will be a part of pneumonia treatment. The swallowing reflex in elderly people was temperature-sensitive and the improvement of swallowing reflex by temperature stimuli could be mediated by the thermosensing TRP channels at pharynx. The administration of capsaicin as an agonist stimulus of TRPV1, a warm temperature receptor, decreased the delay in swallowing reflex. Red wine polyphenols improved swallowing reflex by enhancing TRPV1 response. Food with menthol, agonist of TRPM8 which is a cold temperature receptor, also decreased the delay in swallowing reflex. Olfactory stimulation such as black pepper was useful to improve the swallowing reflex for people with low ADL levels or with decreased consciousness. Thus, recent advancement of geriatrics found several anti-aspiration drugs such as thermosensing TRP channel agonists, black pepper odor, amantadine, cilostazol, theophylline and angiotensin- converting enzymes inhibitors. Thermosensing TRP channel agonists include capsaicin, capsiate, menthol, and red wine polyphenols. Controls of swallowing are mediated by various stages of neural system from peripheral sensory nerves to the entire cerebral cortex. Each anti-aspiration drug acts on various sites of neural axis of swallowing reflex. The combination of various anti-aspiration drugs may improve dysphagia and prevent aspiration pneumonia.
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PMID:Thermal taste and anti-aspiration drugs: a novel drug discovery against pneumonia. 2388 80


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