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There is a common belief that aspiration is a poor prognostic factor; however, the diagnosis of aspiration pneumonia (AP) lacks consensus criteria and is mainly based on clinical characteristics typical of the frailty syndrome. Therefore, the poor prognosis of AP may also be a result of frailty rather than aspiration. This study investigated the impact of AP and other prognostic factors in older patients with pneumonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of patients aged 75\u00a0years and older, admitted with pneumonia in 2021. We divided patients according to their initial diagnosis (AP or non-AP), compared outcomes using Kaplan\u2013Meier curves, and used logistic regression to identify independent prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      803 patients were included, with a median age of 84\u00a0years and 52.7% were male. 17.3% were initially diagnosed with AP. Mortality was significantly higher in those diagnosed with AP than non-AP during admission (27.6% vs 19.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024) and at 1\u00a0year (64.2% vs 53.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018), with survival analysis showing a median survival time of 62\u00a0days and 274\u00a0days in AP and non-AP, respectively (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20099.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). However, the initial diagnosis of AP was not an independent risk factor for poor prognosis in multivariable analysis. Old age, frailty and cardio-respiratory comorbidities were the main factors associated with death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The greater mortality in AP may be a result of increased frailty rather than the diagnosis of aspiration itself. This supports our proposal for a paradigm shift from making predictions based on the potentially futile labelling of AP or non-AP, to considering frailty and overall condition of the patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s41999-023-00929-0","type":"journal-article","created":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T12:02:12Z","timestamp":1706961732000},"page":"481-488","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty?"],"prefix":"10.1007","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0913-3507","authenticated-orcid":false,"given":"Yuki","family":"Yoshimatsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heledd","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Smithard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,3]]},"reference":[{"key":"929_CR1","volume-title":"The principles and practice of medicine, designed for the use of practitioners and students of medicine","author":"W Osler","year":"1892","unstructured":"Osler W (1892) The principles and practice of medicine, designed for the use of practitioners and students of medicine, 1st edn. 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The sponsor had no role in this study design, review process, writing of the manuscript, or decision to publish. The authors received no other financial support for the research, authorship and publication of this article. The authors declare that they have no other competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Ethical approval was obtained from the Lewisham and Greenwich NHS Trust (Number 7211).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was waived due to the retrospective nature of the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}