title: Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study.
abstract: OBJECTIVE
  To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community-dwelling older adults.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Memphis, Tennessee, and Pittsburgh, Pennsylvania.
  
  
  METHODS
  Of 3,075 well-functioning community-dwelling adults aged 70 to 79 enrolled in the Health, Aging, and Body Composition Study from 1997 to 1998, 1,441 had complete data in the data set of all variables used, a dental examination within 6 months of baseline, and were eligible for this study.
  
  
  METHODS
  The primary outcome was pneumonia requiring hospitalization through 2008.
  
  
  RESULTS
  Of 1,441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male sex (hazard ratio (HR) = 2.07, 95% confidence interval (CI) = 1.51-2.83), white race (HR = 1.44, 95% CI = 1.03-2.01), history of pneumonia (HR = 3.09, 95% CI = 1.86-5.14), pack-years of smoking (HR = 1.006, 95% CI = 1.001-1.011), and percentage of predicted forced expiratory volume in 1 minute (moderate vs mild lung disease or normal lung function, HR = 1.78, 95% CI = 1.28-2.48; severe lung disease vs mild lung disease or normal lung function, HR = 2.90, 95% CI = 1.51-5.57) were nonmodifiable risk factors for pneumonia. Incident mobility limitation (HR = 1.77, 95% CI = 1.32-2.38) and higher mean oral plaque score (HR = 1.29, 95% CI = 1.02-1.64) were modifiable risk factors for pneumonia. Average attributable fractions revealed that 11.5% of cases of pneumonia were attributed to incident mobility limitation and 10.3% to a mean oral plaque score of 1 or greater.
  
  
  CONCLUSIONS
  Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors that 22% of pneumonia requiring hospitalization could be attributed to. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut 06520, USA. manisha.juthani@yale.edu
authors.forename: Manisha
authors.initials: M
authors.lastname: Juthani-Mehta
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Rekeneire
authors.forename: Heather
authors.initials: H
authors.lastname: Allore
authors.forename: Shu
authors.initials: S
authors.lastname: Chen
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Sachin
authors.initials: S
authors.lastname: Yende
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weyant
authors.forename: Stephen
authors.initials: S
authors.lastname: Kritchevsky
authors.forename: Vincent
authors.initials: V
authors.lastname: Quagliarello
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D003774:Dental Plaque Index; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D009910:Oral Hygiene; D010414:Pennsylvania / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology
keywords: community-dwelling; pneumonia; risk factors