PNEUMONIA IN THE ELDERLY - SPECIAL DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS

The epidemiology and treatment of pneumonia have changed in recent years. Long a problem in later life, pneumonia has become even more common in today's elderly. As the proportion of older persons in the population continues to grow, the incidence of pneumonia can be expected to rise. Yet even now, the personal and societal costs of pneumonia in the aged are great. Currently the cost of treating bacterial pneumonia alone in the elderly is upwards of a billion dollars a year.(2, 56, 63) Although outcome in pneumonia depends primarily on the presence of underlying illness and the identity of the causative organism, mortality is generally higher in older than in younger patients.(32, 45, 63) For example, patients over the age of 65 are three to five times more likely to die from pneumococcal pneumonia than their younger counterparts. Elderly patients also need to be hospitalized more often, stay in the hospital longer, and experience more complications from pneumonia than younger patients.(8) Because older patients are often sicker at presentation and are more likely to die within 24 hours of admission, some authors have suggested that delays in diagnosis and in initiation of appropriate treatment may be contributing to the higher death rate in the elderly population.(1) Although that may or may not be true, early recognition does provide the best hope of averting morbidity and mortality in this highly vulnerable segment of the population. Unquestionably, however, pneumonia in the elderly poses a number of diagnostic and therapeutic challenges. Those, along with the often unique features of common lower respiratory tract infections in the elderly, are the focus of this article.