Pneumonia in the Elderly

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Pneumonia is a frequent condition in the elderly (≥65 years of age), a population group that is constantly increasing in number, and is characterized by high morbidity and mortality rates, being the first infectious cause of death in this group. This condition has specific features different from those found among younger patients. Its incidence is higher, with around 25 to 40 cases per 1000 inhabitants per year, and this figure increases in more elderly patients. Age as an isolated factor is not of great importance to suffer pneumonia, and the increased risk would be due to interaction of factors such as immune competence, concurrent illnesses, and nutritional factors. Aspiration is the main mechanism that causes pneumonia in the elderly. Although the lack of characteristic clinical data has been a constant feature, it has been recently shown that a very large number of these patients present clinical data suggestive of pneumonia. The main characteristic is altered mental status, accounting for 20% to 50% of the cases. The most common etiologic agent is Streptococcus pneumoniae, followed by Haemophilus influenzae, while the number of cases of gram-negative enteric pathogens and Pseudomonas aeruginosa is lower than what has been previously described. Treatment, both in outpatient clinics and in hospital, would involve the combination of a β-lactam and a macrolide agent, or an antipneumococcal fluoroquinolone alone. Mortality rates are higher in this group, more than 10%, but age is not a related prognostic factor. As preventive measures, influenza and pneumococcal vaccinations are recommended.

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