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Recent Pneumonia Findings For the Elderly

RMpneumonia

There are two encouraging developments for helping prevent pneumonia in the elderly:

First, the Centers for Disease Control and Prevention (CDC) has recently issued new vaccination recommendations for older adults that should increase their protection against this dangerous lung infection.

Second, a large-scale study has found that when the elderly go to hospitals with pneumonia, the hospitals have been doing a much measurably better job of treating them than in the past.

Each year, pneumonia inflicts 3-4 million American adults, mostly elderly, according to a VA Pittsburgh Healthcare article published in JAMA Internal Medicine. More than a million people are hospitalized because of pneumonia, but needing to be hospitalized has been proven to be much more common in the elderly.

In 2003, the Centers for Medicare and Medicaid Services — which tracks how well hospitals do at treating pneumonia — established seven performance measures. To receive reimbursement, hospitals had to report how frequently they took these steps, including taking cultures in the emergency room to diagnose bloodstream infections, starting appropriate antibiotics within six hours, and offering flu and pneumonia vaccines and smoking-cessation counseling to prevent future infections. Viruses, fungi and aspirated food can also cause pneumonia, but only bacterial causes can be effectively treated with antibiotics.

To see how hospitals responded, the researchers examined the records of almost 2 million Medicare beneficiaries hospitalized with pneumonia between 2006 and 2010. They not only looked at how frequently the nearly 5,000 hospitals managed to complete each of the seven processes; they also constructed a composite — an “all-or-none” measure — which showed how often hospitals took all the required actions patients were eligible for.

In 2006, only a little over half of hospitals took all the required steps for all eligible pneumonia patients, the researchers found. Five years later, that proportion had risen to more than 85 percent. There has been major improvement over time. In fact, some measures became so universally practiced that Medicare has stopped feeling the need to even track them.

Even though the elderly patients (average age of just under 80) in this study had become sicker, with higher admissions to the intensive care unit and more comorbidities (more than one illness at a time), they were more apt to recover. Over five years, the researchers found small but significant reductions in mortality and in hospital readmissions – which is the reason they are concerned about the medical staff members checking off all their requirements.

However, within one month of their admissions, over 10 percent of these patients still had ended up dying and more than 20 percent went back into a hospital after being discharged. It’s apparent that older people would simply do better by avoiding pneumonia in the first place, which is where the new vaccination recommendations come into play.

For three decades, the CDC has recommended a pneumonia vaccine — a one-time inoculation with something called a polysaccharide vaccine — for everyone over 65 years old. In the recent past, the CDC advised that seniors should receive an additional pneumonia vaccine: first a shot of the pneumococcal conjugate vaccine (already in wide use for children) and then, 6-12 months later, the current polysaccharide vaccine.

The conjugate vaccine results in a burst of antibodies. To get the most benefit from it, you have to let the body’s immune system respond to the first, take a deep breath, then go with the second. Studies have shown that this regimen is more effective than the reverse. (If you have already had the current polysaccharide vaccine, however, you can add the conjugate vaccine after one full year. Additionally, you can get your annual flu shot at the same time as either of these. Influenza is a virus, therefore the flu vaccine an entirely different type of vaccine.

The CDC responded to this method of treating pneumonia in the elderly after a large clinical trial in the Netherlands, called CAPiTA, showed better protection against “community-acquired pneumonia” – about half – when older people received the conjugate vaccine (brand name: Prevnar 13), which protects against 13 strains of pneumococcal bacteria. The current polysaccharide vaccine (Pneumovax23) protects against 23 strains and also helps prevent complications like meningitis and bloodstream infections. Prevnar 13 also reduced invasive pneumonia, a rare but often lethal infection, by 75 percent. Side effects for both vaccines are low, primarily soreness from the injection.

If you’re just starting to get pneumonia vaccinations, you can start with the conjugate vaccine, Prevnar 13, which is the more expensive — and hope that by the time a year has passed, Medicare will also cover Pneumovax23, the polysaccharide vaccine. If you have already had Pneumovax and now want to add Prevnar, you may have to pay about $140 out of pocket.

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