Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging

Abstract

Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy. Streptococcus pneumoniae remains the most frequently reported pathogen in this population. However, particular attention should be paid to patients with risk factors for multidrug resistant pathogens, because a large proportion of elderly persons present multimorbidity. Vaccination is one of the most important preventive approaches for CAP in the elderly. In addition, lifestyle-tailored interventions for different modifiable risk factors will help to reduce the risk of pneumonia in elderly persons. Surveillance of etiological pathogens may improve vaccination policies in this population.

Community-Acquired Pneumonia in Adults: What’s New Focusing on Epidemiology, Microorganisms and Diagnosis?

“…General worsening of health is related to an aging population worldwide. The high proportion of elderly individuals (>65 years) suffering from one or several comorbidities and an increase in the ineffectiveness of the immune system are responsible for the rise of infectious diseases in the elderly and are associated with a higher risk of mortality (1). Pneumonia is an inflammatory disease of the lung due to infectious microorganisms in the lower respiratory tract.…”

Is macrolide and beta-lactam combination therapy associated with early clinical stability or 30 day mortality in hospitalized patients with pneumonia? An assessment of confounding by indication.

“…It is estimated that 1 of every 20 persons aged 85 years or greater will have a new episode of CAP each year (10). Those with increased age often have at least one other medical condition which can complicate CAP (11). Elderly patients categorized as frail (i.e.…”

“…Elderly patients categorized as frail (i.e. those who need help with daily activities, who have severe multimorbiditiy, polypharmacy, and possible dementia) are at a much higher risk of CAP than those who have who are not frail (11,12). However, even without comorbidities, age is an independent risk factor for CAP due to the decreased ability of the immune system to protect against pathogens, decreased ability to have a productive cough, and decreased swallowing reflex (13).…”

“…The score includes demographic information, comorbidities, initial physical exam results, lab results, and radiographical results (56). PSI scores have low sensitivity and specificity for intensive care unit (ICU) admission, and they do not account for other variables affecting severity such as psychosocial variables, non-common comorbidities, or patient preferences regarding treatment (11).…”

“…The CRB-65 score provides a four-variable substitute for use where blood testing is not available. The CURB-65 scores do not include data such as hypoxemia, electrolyte disturbance or the inability to take oral medications which could indicate greater severity of CAP (11).…”