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11/6/2001

Study Links Sedatives, Pneumonia

Kate Traynor

The results of a study involving elderly residents of a Veterans Affairs (VA) long-term care facility suggest a link between the use of sedatives and the development of pneumonia.

In the study, patients with pneumonia were 2.6 times as likely as control patients to have received a "tranquilizer," such as haloperidol or a phenothiazine, benzodiazepine, or barbiturate, in the two weeks preceding diagnosis of the respiratory-tract disease.

Two factors other than sedative use—an observed instance of food aspiration and a higher-than-normal score on an index that assessed comorbid conditions—also seemed to increase a patient's likelihood of having a pneumonia episode. Patients who aspirated food were at a nearly 14-fold increased risk of pneumonia two weeks later. An increased score on the comorbidity index was associated with a 20 percent increase in pneumonia risk.

The study’s findings were reported in the Oct. 22 Archives of Internal Medicine.

The researchers identified 104 cases of pneumonia during the study, which took place at a Pittsburgh VA long-term care facility from Feb. 1, 1997, through Jan. 31, 1998. For each case of pneumonia, the research team selected a control patient of comparable functional status and level of nursing care.

Control patients were also age-matched to within five years of case patients, who averaged 75 years of age. Despite this matching, the control patients were an average of 2.5 years younger than the pneumonia patients—a statistically significant difference.

Information about the case and control patients' medication use and clinical and functional states was gleaned from the medical center's electronic patient records. Functional status was scored using the Activities of Daily Living Index, a standardized assessment tool.

About a quarter of the patients who had pneumonia died within two weeks after onset of the disease.

The use of antidepressant medications did not seem to increase the patients' pneumonia risk. The research team noted that, in their facility, "[T]ricyclic antidepressants have been largely replaced by selective serotonin-reuptake inhibitors," which the researchers described as "generally less sedating" than tricyclic compounds.

According to the report, pneumococcal and influenza vaccine coverage for residents of the long-term care facility exceeded 95 percent during the study.

The research team noted that characteristics of the patients in this VA facility, with its overwhelmingly male population, likely differed from those of community nursing homes. Thus, the authors encouraged other researchers to conduct similar studies in community long-term care settings.