Interventions to prevent pneumonia among older adults

Pneumonia is a common cause of death in older people. Antimicrobial drugs d o not prevent pneumonia and, be cause of increasingly resistant organisms, their value in curing infection will become more limited. Establishing new strategies to prevent pneumonia through consideration of the mechanisms of this devastating illness is essential. The purpose of this review is to dis cuss how pneumonia develops in older people and to suggest preventive strat egies that may reduce the incidence of pneumonia among older adults. Aspira tion of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia; impairments in swall owing and cough reflexes among older adults, e.g., related to cerebrovascul ar disease, increase the risk for the development of pneumonia. Thus, strat egies to reduce the volumes and pathogenicity of aspirated material should be pursued. For example, since both swallowing and cough reflexes are media ted by endogenous substance P, pharmacologic therapy using angiotensin-conv erting enzyme inhibitors, which decrease substance P catabolism, may improv e both reflexes and result in the lowering of the risk of pneumonia. Simila rly, since the production of substance P is regulated by dopaminergic neuro ns in the cerebral basal ganglia, treatment with dopamine analogs or potent iating drugs such as amantadine (and, of course, prevention of cerebral vas cular disease, which can result in basal ganglia strokes) should affect the incidence of pneumonia. The purpose of this review is to consider promisin g pharmacologic treatments as methods of preventing pneumonia in older adul ts and to review other proven strategies, e.g., infection control and cereb rovascular disease prevention that will lessen the incidence of pneumonia.