The management of community-acquired pneumonia in the elderly

Abstract

Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.

Pneumonia and hospitalizations in the elderly

“…9 Common signs and symptoms in elderly are: falls, sudden change in functional status, decreased appetite, urinary incontinence, delirium / acute confusional state, frequent but less common signs are: pleuritic chest pain, cough, dyspnea, fever, and leukocytosis. 10 ( Figure 1). The chest x-ray usually consents to make the diagnosis but does not provide information on the etiology.…”

Macrolides: Are They Safe Bet in Management of Community Acquired Pneumonia (CAP) in Elderly Patients Admitted to an Intensive Care Unit (ICU)

“…Wong et al reported use of clarithromycin was associated with an increased risk of myocardial infarction, arrhythmia, and cardiac mortality short term. Cheng et al reported administration of macrolide antibiotics is associated with increased risk for sudden cardiac death or ventricular tachyarrhythmia and cardiovascular death but not increased all-cause mortality [36][37][38] [42]. Justo and Zeltser reported that simple history taking and baseline electrocardiogram could predict "torse de pointes" induced by antibiotics [43].…”

Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE) study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT)

“…Also, outcome of pneumonias (CAP and HCAP) is strongly affected by host and process factors, including older age, 13 failure of initial therapy, 9,13 comorbidity, 1,2,13 impaired mobility, 11 nursing home residency, 13 as well as by the severity of pneumonia [8][9][10]13 and the susceptibility to and adequate management of pneumonia-related complications (mainly acute respiratory failure and sepsis). 1 Consequently, even though older and frail patients frequently correspond to the ATS/IDSA definition of HCAP, it is plausible that the involvement of MDR pathogens or the presence of HCAP criteria do not entirely account for the increased incidence and severity of pneumonia in the elderly. 2 For instance, the value of comprehensive geriatric assessment (CGA) in predicting prognosis of pneumonia in the elderly compared with both disease-specific severity scores and HCAP criteria is an interesting applicative topic deserving further investigation.…”

“…1,2 The rate of pneumonia is increased in the elderly compared to younger populations 1,2 and the short-term prognosis of older persons after a pneumonia episode may be poor, 3 mainly because of comorbid diseases which contribute to death. 1,2 Thus, timely identification and appropriate treatment of pneumonia in elderly persons are crucial clinical issues. 1,2 There are 3 types of pneumonia.…”

“…1,2 Thus, timely identification and appropriate treatment of pneumonia in elderly persons are crucial clinical issues. 1,2 There are 3 types of pneumonia. [4][5][6][7] Community-acquired pneumonia (CAP) is the typical form of pneumonia arising out-of-hospital in subjects without previous contact with the healthcare system.…”