Pneumonia patients nearly twice as likely to suffer from depression, impairments

(Press-News.org) ANN ARBOR, Mich. — The long-term consequences of pneumonia can be more detrimental to a person's health than having a heart attack, according to joint research from the University of Michigan Health System and University of Washington School of Medicine.

Older adults who are hospitalized for pneumonia have a significantly higher risk of new problems that affect their ability to care for themselves, and the effects are comparable to those who survive a heart attack or stroke, according to the new findings in the American Journal of Medicine.

"Pneumonia is clearly not only an acute life threatening event but also a profoundly life altering event," says senior author Theodore J. Iwashyna, M.D., Ph.D., assistant professor of internal medicine at U-M and who also works with the Institute of Social Research and the VA Center for Clinical Management Research. "The potentially substantial chronic care needs and diminished quality of life for survivors are comparable to the effects of heart disease, yet we invest far fewer resources to pneumonia prevention."

Patients who were treated for pneumonia – including those hospitalized even once in a nine-year period and who did not require critical care – were more than twice as likely to develop new cognitive impairments. These new brain problems were so big that they often lead to disability and nursing home admissions among older adults. After treatment for pneumonia, patients also had nearly double the risk of substantial depressive symptoms.

Following hospitalization, patients with pneumonia also had much increased risk of losing the ability to maintain daily life activities such as walking, cooking meals or being able to use the bathroom without assistance.

"Even non-critical pneumonia hospitalization can lead to long term adverse outcomes at a magnitude much greater than we previously thought," says lead author Dimitry S. Davydow, M.D, M.P.H., assistant professor of psychiatry at U-W. "Pneumonia prevention and interventions are crucial given the costly and detrimental consequences for patients."

Pneumonia accounts for roughly 390,000 hospitalizations among older adults a year, costing Medicare more than $7.3 billion – and hospitalizations for the condition are expected to double by 2040. Nearly half of pneumonia survivors die within a year.

Prevention methods include improved timeliness and appropriateness of antibiotics, vaccination against influenza and screening older adults for depression following pneumonia.

### The study was conducted with participants of the Health and Retirement Study, a nationally-representative sample of older Americans that is conducted by the U-M Institute for Social Research on behalf of the National Institute of Aging.

Additional Authors: Catherine L. Hough, M.D., M.Sc., U-W; Deborah A. Levine, M.D., M.P.H., U-M and VA; Kenneth M. Langa, M.D., Ph.D., U-M and VA.

Disclosure: None

Funding: Grants KL2 TR000421, K08 HL091249, R01 AG030155, and U01 AG09740 from the National Institutes of Health.

Reference: "Functional Disability, Cognitive Impairment, and Depression After Hospitalization for Pneumonia," American Journal of Medicine, doi:10.1016/j.amjmed.2012.12.006.