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Expired CME Article

Pneumonia in the Elderly: A Review of the Epidemiology, Pathogenesis, Microbiology, and Clinical Features

Carol P. Chong, FRACP, Philip R. Street, FRACP
Volume: 101 Issue: 11 November, 2008

Abstract:

Pneumonia is a common and important disease in the elderly. The incidence is expected to rise as the population ages, and, therefore, it will become an increasingly significant problem in hospitals and the community. A comprehensive literature review was performed in order to look at the characteristics of pneumonia in the elderly population. In particular, the epidemiology, etiology and pathogenesis—including risk factors, microbiology, and clinical features—were evaluated. While aging causes physiological changes which make elderly patients more susceptible to pneumonia, it was found that comorbidities, rather than age, are also an important risk factor. The most common micro-organism responsible for pneumonia is Streptococcus pneumoniae, but other organisms need to be considered, depending on the environment of presentation. Elderly patients are more likely than younger adults to present with an absence of fever and an altered mental state. Nursing home residents tend to present with more atypical and less characteristic symptoms.

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References:

References1.Janssens J-P, Krause K-H. Pneumonia in the very old. Lancet Infect Dis 2004;4:112–124.JanssensJP]]KrauseKHPneumonia in the very old.Lancet Infect Dis20044112-1242.Marrie TJ. Pneumonia in the long-term-care facility. Infect Control Hosp Epidemiol 2002;23:159–164.MarrieTJPneumonia in the long-term-care facility.Infect Control Hosp Epidemiol200223159-1643.Muder RR. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Am J Med 1998;105:319–330.MuderRRPneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention.Am J Med1998105319-3304.El-Solh AA, Sikka P, Ramadan F, et al. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 2001;163(3 pt 1):645–651.El-SolhAA]]SikkaP]]RamadanF&etal;Etiology of severe pneumonia in the very elderly.Am J Respir Crit Care Med20011633 pt 1645-6515.Medina-Walpole AM, Katz PR. Nursing home-acquired pneumonia. J Am Geriatr Soc 1999;47:1005–1015.Medina-WalpoleAM]]KatzPRNursing home-acquired pneumonia.J Am Geriatr Soc1999471005-10156.Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother 2006;7:499–507.Schmidt-IoanasM]]LodeHTreatment of pneumonia in elderly patients.Expert Opin Pharmacother20067499-5077.Kaplan V, Angus DC, Griffin MF, et al. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the united states. Am J Respir Crit Care Med 2002;165:766–772.KaplanV]]AngusDC]]GriffinMF&etal;Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the united states.Am J Respir Crit Care Med2002165766-7728.Koivula I, Sten M, Makela PH. Risk factors for pneumonia in the elderly. Am J Med 1994;96:313–320.KoivulaI]]StenM]]MakelaPHRisk factors for pneumonia in the elderly.Am J Med199496313-3209.Gyetko MR, Toews GB. Immunology of the aging lung. Clin Chest Med 1993;14:379–391.GyetkoMR]]ToewsGBImmunology of the aging lung.Clin Chest Med199314379-39110.Riquelme R, Torres A, El-Ebiary M, et al. Community-acquired pneumonia in the elderly. A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med 1996;154:1450–1455.RiquelmeR]]TorresA]]El-EbiaryM&etal;Community-acquired pneumonia in the elderly. A multivariate analysis of risk and prognostic factors.Am J Respir Crit Care Med19961541450-145511.Zalacain R, Torres A. Pneumonia in the elderly. Clin Pulm Med 2004;11:210–218.ZalacainR]]TorresAPneumonia in the elderly.Clin Pulm Med200411210-21812.Kikuchi R, Watabe N, Konno T, et al. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 1994;150:251–253.KikuchiR]]WatabeN]]KonnoT&etal;High incidence of silent aspiration in elderly patients with community-acquired pneumonia.Am J Respir Crit Care Med1994150251-25313.Tracy JF, Logemann JA, Kahrilas PJ, et al. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia 1989;4:90–94.TracyJF]]LogemannJA]]KahrilasPJ&etal;Preliminary observations on the effects of age on oropharyngeal deglutition.Dysphagia1989490-9414.Oh E, Weintraub N, Dhanani S. Can we prevent aspiration pneumonia in the nursing home? J Am Med Dir Assoc 2004;5:174–179.OhE]]WeintraubN]]DhananiSCan we prevent aspiration pneumonia in the nursing home?J Am Med Dir Assoc20045174-17915.Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665–671.MarikPEAspiration pneumonitis and aspiration pneumonia.N Engl J Med2001344665-67116.Janssens JP. Pneumonia in the elderly (geriatric) population. Curr Opin Pulm Med 2005;11:226–230.JanssensJPPneumonia in the elderly (geriatric) population.Curr Opin Pulm Med200511226-23017.Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002;50:430–433.YoneyamaT]]YoshidaM]]OhruiT&etal;Oral care reduces pneumonia in older patients in nursing homes.J Am Geriatr Soc200250430-43318.Valenti WM, Trudell RG, Bentley DW. Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978;298:1108–1111.ValentiWM]]TrudellRG]]BentleyDWFactors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged.N Engl J Med19782981108-111119.Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 1999;160:397–405.RuizM]]EwigS]]MarcosMA&etal;Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.Am J Respir Crit Care Med1999160397-40520.Fernández-Sabé N, Carratala J, Roson B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine 2003;82:159–169.Fernández-SabéN]]CarratalaJ]]RosonB&etal;Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes.Medicine200382159-16921.Lieberman D, Lieberman D, Schlaeffer F, et al. Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home. Age Ageing 1997;26:69–75.LiebermanD]]LiebermanD]]SchlaefferF&etal;Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home.Age Ageing19972669-7522.Macfarlane JT, Miller AC, Roderick Smith WH, et al. Comparative radiographic features of community acquired Legionnaires’ disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax 1984;39:28–33.MacfarlaneJT]]MillerAC]]Roderick SmithWH&etal;Comparative radiographic features of community acquired Legionnaires’ disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis.Thorax19843928-3323.Finegold SM. Legionnaires’ disease—still with us. N Engl J Med 1988;318:571–573.FinegoldSMLegionnaires’ disease—still with us.N Engl J Med1988318571-57324.Muder RR, Brennen C, Wagener MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.MuderRR]]BrennenC]]WagenerMM&etal;Methicillin-resistant staphylococcal colonization and infection in a long-term care facility.Ann Intern Med1991114107-11225.Andrews J, Nadjm B, Gant V, et al. Community-acquired pneumonia. Curr Opin Pulm Med 2003;9:175–180.AndrewsJ]]NadjmB]]GantV&etal;Community-acquired pneumonia.Curr Opin Pulm Med20039175-18026.Stead WW, Lofgren JP, Warren E, et al. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.SteadWW]]LofgrenJP]]WarrenE&etal;Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes.N Engl J Med19853121483-148727.Murdoch DR, Laing RT, Mills GD, et al. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol 2001;39:3459–3498.MurdochDR]]LaingRT]]MillsGD&etal;Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia.J Clin Microbiol2001393459-349828.Chambers DC, Waterer GW. Are blood cultures necessary in community-acquired pneumonia? Clin Pulm Med 2005;12:146–152.ChambersDC]]WatererGWAre blood cultures necessary in community-acquired pneumonia?Clin Pulm Med200512146-15229.Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 1997;157:1453–1459.MetlayJP]]SchulzR]]LiYH&etal;Influence of age on symptoms at presentation in patients with community-acquired pneumonia.Arch Intern Med19971571453-145930.Johnson JC, Jayadevappa R, Baccash PD, et al. Nonspecific presentation of pneumonia in hospitalized older people: age effect or dementia? J Am Geriatr Soc 2000;48:1316–1320.JohnsonJC]]JayadevappaR]]BaccashPD&etal;Nonspecific presentation of pneumonia in hospitalized older people: age effect or dementia?J Am Geriatr Soc2000481316-132031.McFadden JP, Price RC, Eastwood HD, et al. Raised respiratory rate in elderly patients: a valuable physical sign. Br Med J (Clin Res Ed) 1982;284:626–627.McFaddenJP]]PriceRC]]EastwoodHD&etal;Raised respiratory rate in elderly patients: a valuable physical sign.Br Med J (Clin Res Ed)1982284626-627

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