Community-acquired pneumonia in the elderly.

CAP is traditionally considered a medical disease, and is managed with intravenous fluids and antibiotics on medical floors. Recent cost-containment efforts have shifted the provision of care to the outpatient settings, and only those with most severe disease and multiple comorbid illnesses are admitted to hospitals. Therefore, the proportion of hospitalized patients with severe CAP that need intensive care and life support is increasing. Furthermore, the incidence of severe CAP is also rising due to disproportionate growth of the elderly population that is most vulnerable to this deadly disease. Many of these elderly patients have advanced underlying diseases, and CAP might often be a terminal event superimposed on an underlying chronic debilitating illness. As ICU physicians, we need to be familiar with this disease, its complications, and its prognosis to provide intensive care in a timely and rational fashion in some patients, and refrain from life support in others. Just as prior efforts have sought to improve and standardize criteria for hospital admission, future efforts should aim to improve and standardize decisions regarding intensive care and life support in these very sick elderly patients. Future efforts in the management of CAP need to consider the postdischarge period where most deaths occur. Prevention is an important issue especially for those at high risk for CAP.