A Swedish population-based study finds that older men with lower respiratory tract infections (LRTI) had a greater likelihood of health decline vs men who did not have them. And women did not show any statistically significant differences in health decline. The population was assessed utilizing the Health Assessment Tool (HAT) that examined individuals’ conditions at 7 years and 12 years post-infection.1
The first follow-up at 7 years saw a greater health decline than in the later years according to the investigators’ findings. “LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period,” the authors wrote in the study that was published in BMC Infectious Diseases.
Study Parameters
The study included 2796 participants who were 60 years of age and older, and of them, 567 were diagnosed with a LRTI. The investigators used information obtained from the Swedish National Patient Register, and individuals’ objective health status was assessed using HAT. This tool used indicators to assess mild and severe disability, cognitive and physical functioning, and multimorbidity. (See the sidebar for more information.) LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders.
Participants completed questionnaires and had exams by a physician, nurse, and psychologist at each visit.
HAT Indicators
Participants were objectively quantified on 5 geriatric measures including:
Personal Activities of Daily Living (P-ADL): Severe disability or dependence in fundamental self-care tasks (e.g., bathing, dressing, eating).
Instrumental Activities of Daily Living (I-ADL): Mild disability or difficulty managing more complex daily tasks (e.g., managing finances, shopping, or using transportation).
Cognitive Function: Assessed by the Mini-Mental State Examination (MMSE), a decline indicates reduced cognitive abilities such as memory, attention, or problem-solving.
Physical Function: Measured by gait speed tests (6-meter or 2.44-meter for individuals with walking difficulties). Declines in physical function reflect slower walking speed or difficulty walking.
Chronic Disease Burden: Increases in the number of chronic diseases diagnosed, as determined through clinical evaluations, self-reports, and other medical records.
Sidebar created through ChatGPT.
It is important to note this study was performed prior to the pandemic, and data was collected and analyzed between 2001 and 2016.
Potential Long-Term Health Effects
The health care burden of LRTI in Sweden in recent years has been serious, as these infections were the eighth leading cause of mortality in 2019. “The incidence of LRTIs has been on the rise among adults aged 70 years and above worldwide as well as among individuals aged 65 and older in Sweden. Moreover, sex differences have been observed in relation to LRTIs, with males, particularly those aged 70 years and above, having a higher incidence and increased immediate mortality following infection,” the investigators wrote.
The investigators pointed out some of the long-term issues associated with LRTI including cognitive decline 2-5 years after the acute infection, as well as the potential increase in health risks after individuals have been either hospitalized or needed specialist care. “The risk of mortality can remain elevated for up to 16 years, and healthcare utilization for up to 5 years from the LRTI episode,” they wrote.
As such, they reinforced interventions aimed at prevention to avoid long-term health issues.
“LRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age,” they wrote.
Reference
1.Abbadi, A., Beridze, G., Tsoumani, E. et al. Sex differences in the impact of lower respiratory tract infections on older adults’ health trajectories: a population-based cohort study. BMC Infect Dis 24, 1227 (2024). https://doi.org/10.1186/s12879-024-10131-7
