Pneumonia Takes Aim at Most Vulnerable by Gina Shaw It took the life of comedian Bob Hope in July of last year, Madame Chiang Kai-Shek in October, and legendary Chicago Sun-Times columnist Irv Kupcinet in November. It also sent famed novelist Stephen King, weakened by his 1999 car accident, to the hospital. "It" is pneumonia, an inflammation of the lungs caused by infection that affects between 3 million and 4 million people annually in the United States alone and is the fifth leading cause of death in the country, according to the National Institute of Allergy and Infectious Diseases. Worldwide, pneumonia kills some 3.5 million people every year. SARS (severe acute respiratory syndrome) may be the respiratory infection that has gotten most of the headlines over the last year, but itís a 98-pound weakling compared to pneumonia. Like many infections, pneumonia takes aim at the most vulnerable: children, people with compromised immune systems and the elderly. In fact, one of the biggest risk factors for developing pneumonia is simply getting older. (Years ago, pneumonia was called the "old manís friend," seen as ending the suffering of the old and ill.) Studies have found that pe ople over 75 face a six-fold greater risk of contracting pneumonia than people under 60. In fact, pneumonia is one of the top five killers of people 65 and older in the United States. Nursing home residents are at particular risk. Not only do they get pneumonia more frequently than other older people, it is also more fatal for them: As many as 44 percent of nursing home residents who develop pneumonia die from it. Pneumonia can strike at any time, but it is particularly active in the fall and winter and often follows a cold or the flu. Two types of pneumonia that are particularly threatening to older people are pneumococcal pneumonia, also called strep pneumonia, and aspiration pneumonia, a form of the disease acquired when a person accidentally inhales materialósuch as foodófrom the throat, nose or stomach. Caused by a bacterial infection, pneumococcal pneumonia can be treated with antibiotics, but like many other bacterial diseases, it has become more drug resistant over the years. That is one of the reasons why the Centers for Disease Control and Prevention advises people over the age of 65 to get vaccinated for the pneumococcal type of pneumonia. Unlike the flu shot, the pneumonia vaccine doesnít have to be taken every year, and after the initial shot, seniors can wait five years before getting a booster vaccination, after which they need no more pneumococcal shots. Unfortunately, many elderly people may know about the flu vaccine thanks to community vaccination efforts, but as many as half of seniors still have not gotten the vaccine for pneumococcal pneumonia. Pneumonia vaccination took a hit in April 2003 when a large Group Health Cooperative study, which assessed three years of medical records from nearly 50,000 seniors, found that the vaccine didnít appear to prevent pneumonia or reduce hospitalizations from the disease. If that is true, then why get the vaccine? Because even if the vaccine cannot prevent pneumonia, studies indicate that it does reduce the rates of life-threatening complications, thus preventing deaths from pneumonia. "Itís still definitely important to give the pneumococcal vaccine to seniors," said Dr. William Furlong, an infectious diseases specialist and chair of the Infection Control Committee at Virginia Hospital Center in Arlington, Va. "Bacteremia, a blood infection, can often be a fatal complication with this type of pneumonia, and the Group Health study and others have shown that pneumonia patients whoíve had the vaccine are only half as likely to get bacteremia. That means it does save a lot of lives, even if it doesnít keep you out of the hospital." The Group Health study also found that the regular flu shot reduces the incidence of pneumonia acquired as a result of the fluóanother reason for seniors to be vigilant about their flu shots. Another good way to prevent pneumonia: Donít visit grandma and grandpa when the kids have colds or the flu. That may not be easy to do in the winter, Furlong admitted, "but the bacterial complications of influenza can be deadly for older people." What about aspiration pneumonia, which kills 50,000 people in the United States alone each yearómost of them elderly? Obviously, no vaccine can prevent someone aspirating their own food or saliva. "Itís a particular problem with patients whoíve had a stroke and with people who have Parkinsonís disease," said Furlong. "Their swallowing mechanisms can be damaged." One of the best ways families can help prevent aspiration pneumonia in older loved onesóespecially those in nursing homesóis to resist the urge to provide too much food. "Families want to be helpful and bring in food from homeótreats that are better than the standard nursing home food. They mean well. But if people are eating too much, too aggressively, or in bed when theyíre not supervised, they might aspirate," explained Furlong. "Especially in patients whose swallowing mechanisms might be abnormal, itís best to let them eat what theyíre supposed to eat. If theyíre on a diet of pureed food, understandably that doesnít look too tasty, but thereís a reason for it." Families worried that an elderly relative may have swallowing problems that could lead to aspiration pneumonia should get a hospital assessment of their swallowing, Furlong said. Virginia Hospital Center is one of a number of hospitals that uses the Fiberoptic Endoscopic Evaluation of Swallowing (FEES), which provides a real-time view of how a patient swallows and lets therapists pinpoint techniques that can improve a patientís swallowing to reduce the risk of aspiration pneumonia. Gina Shaw is the medical writer for The Washington Diplomat.