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Minerva Pneumologica 2003 June;42(2):41-58

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: Italian

Pneumonia in the elderly: diagnostic and therapeutic approaches

Cazzola M., Bellia V.

Pneumonia is the most serious of the common infections that occur in the elderly, with a high case-fatality rate and considerable mortality among survivors. The high incidence of infection is the result of aging itself, as well as age-related coexisting illnesses and their therapies. Risk factors for pneumonia in the elderly have been defined, and prediction models for death due to pneumonia in the elderly have been developed. The bacterial etiology of pneumonia in the elderly has been debated, but ''typical'' bacterial pathogens (Streptococcus pneumoniae, followed by Legionella pneumophila, Haemophilus influenzae, Chlamydia pneumoniae and enteric gram-negative bacilli) are most important. Diagnosis of pneumonia in the elderly is often thwarted by difficulties in recognizing infection, as signs and symptoms differ from those observed in younger patients. Clinical presentation of pneumonia in elderly is said to be ''atypical'', but this also may be confounded by dementia. Specific therapeutic measures include administration of appropriate antibiotics, correction of fluid and electrolyte imbalances, nutritional support and treatment of concomitant disorders. Prophylaxis includes the use of pneumococcal and influenza vaccines.