Pneumonia in the elderly--what makes the difference?

Pneumonia has a particularly high incidence in the elderly, the cardinal risk factors being comorbidity and malnutrition. The independent bearing of age on the aetiology of pneumonia is a matter of controversy and is probably limited. Streptococcus pneumoniae is uniformly the most frequent pathogen. Elderly patients with pneumonia are frequently oligosymptomatic. Quite often, mental confusion may be the only clinical symptom. Physical and chest radiograph examination have specific and important pitfalls. Mental confusion as a surrogate marker of severe sepsis should be added to the criteria for assessing the severity of disease. Pneumonia in the elderly is associated with a considerably increased mortality, but age does not appear to be an independent predictor of death. The disease continues to be the old man's friend: survivors of a pneumonia episode are more likely to die during follow-up as compared to controls. Antimicrobial treatment in the elderly should follow a risk-adopted approach. When selecting antimicrobial agents for the treatment of the elderly, peculiarities in pharmacokinetics, drug interactions and side effects should be considered. The rate of radiographic clearance is inversely correlated with age. All elderly individuals are candidates for vaccination against pneumococci and influenza, particularly in the presence of cardiopulmonary comorbidity and any degree of immunosuppression.