Pneumonia in the Elderly

Ali   A.   El Solh

Abstract

Pneumonia is the fourth overall leading cause of death and is the leading infectious cause of death in the elderly. Half of all pneumonia cases are reported in those 65 years of age and older. The increased frequency and severity of pneumonia in this age group is attributed to the aging of organ systems and the increased frequency of debilitating comorbidities. Risk factors include aspiration, alcoholism, heart disease, malnutrition, and immunosuppression. Recognition may be delayed because pneumonia often presents without fever, cough, or chest pain. Accurate identification of the etiological agent is reported to be less than 50% of the cases as sputum specimens are considered either inadequate or contaminated by the oropharyngeal flora. The pathogens involved depend on the setting in which the pneumonia develops: either the non-hospitalized elderly patients with community-acquired pneumonia or the institutionalized patients who develop nursing home-acquired pneumonia. The timing of administration and the choice of antibiotic therapy are highly correlated with outcome. A systematic approach to assessment, management, and preventive measures is essential to decrease morbidity and mortality from pneumonia. The purpose of this review is to summarize the current evidence associated with the etiology, risk factors, clinical presentation, management, and prevention of nonmycobacterial community-acquired and nursing home-acquired pneumonia in persons aged 65 years and older.

Keywords: Community-acquired pneumonia, nursing home-acquired pneumonia, etiology, treatment, prevention, drugresistant bacteria

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