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Pneumonia in older people

Published online by Cambridge University Press:  03 November 2010

S Krajcik ,
T Haniskova  and
P Mikus
S Krajcik*
Affiliation:
Geriatric Department of Slovak Medical University and University Hospital, Bratislava, Slovakia
T Haniskova
Affiliation:
Geriatric Department of Slovak Medical University and University Hospital, Bratislava, Slovakia
P Mikus
Affiliation:
Geriatric Department of Slovak Medical University and University Hospital, Bratislava, Slovakia
*
Address for correspondence: S Krajcik, Geriatric Department of Slovak Medical University, Krajinska 91, 825 56 Bratislava, Slovakia. Email: stefan.krajcik@szu.sk
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Summary

The incidence of pneumonia is higher in older than younger people, due to both an increase in factors facilitating entry of infectious agents into the lungs, and attenuated functioning of the immune system. Classic features of presentation of pneumonia may be absent. The most common signs of pneumonia in old age are tachypnoea and tachycardia. Aetiology is established in only 50% of older patients. The empirical treatment of community-aquired pneumonia (CAP) should be aimed at its most common cause, Streptococcus pneumoniae. The empirical treatment of health care-associated pneumonia (HCAP) should be targeted at Gram-negative agents. Choice of antibiotic must include consideration of potential drug interactions.

Keywords

old agepneumoniarespiratory disease
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 1 , February 2011 , pp. 16 - 27
Copyright
Copyright © Cambridge University Press 2010

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References

1Health Statistics Yearbook of the Slovak Republic 2001, p. 72, Bratislava, UZIS, ISBN 80-967-476-6-5.Google Scholar
2Health Statistics Yearbook of the Slovak Republic 2007, p. 51, Bratislava, Narodne centrum Zdravotnickych informácií, ISBN 978-80-89292-13-4.Google Scholar
3Trotter, CL, Stuart, JM, George, R, Miller, E. Increasing hospital admissions for pneumonia England. Emerg Infect Dis 2005; available at: http://www.cdc.gov/EID/content/14/5/727.htm.Google Scholar
4Jokinen, C, Heiskanen, H, Juvonen, H. Incidence of community acquired pneumonia in the population of four municipalities in Eastern Finland. Am J Epidemiol 1993; 137: 977–88.Google Scholar
5Wesley, Ely E. Pneumonia in the elderly: diagnostic and therapeutic challenges. Infect Med 1997; 14: 643–54.Google Scholar
6Koivula, I, Sten, M, Makela, PH. Risk factors for pneumonia in the elderly. Am J Med 1994; 96: 313–20.CrossRefGoogle ScholarPubMed
7Hedlund, JU, Örtquist, AB, Kalin, ME, Granath, F. Factors of importance for the long term prognosis after hospital treated pneumonia. Thorax 1993; 48: 785–89.Google Scholar
8Terpenning, MS, Taylor, GW, Lopatin, DE, Kerr, CK, Dominguez, BL, Loesche, WJ. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc 2001; 49: 557–63.CrossRefGoogle Scholar
9Abe, S, Ishihara, K, Adachi, M, Okuda, K. Tongue-coating as risk indicator for aspiration pneumonia in edentate elderly. Arch Gerontol Geriatr 2008; 47: 267–75.Google Scholar
10Abe, S, Ishihara, K, Okuda, K. Prevalence of potential respiratory pathogens in the mouths of elderly patients and effects of professional oral care. Arch Gerontol Geriatr 2001; 1: 45–55.Google Scholar
11Flamaing, J, Verhaegen, J, Peetermans, WE. Abstr Intersci Conf Antimicrob Agents Chemother 2001; 41: abstract no. L-896.Google Scholar
12Marik, PE, Kaplan, S. Aspiration pneumonia and dysphagia in the elderly. Chest 2003; 124: 328–36.Google Scholar
13Paik, NJ. Dysphagia. Available at: http://emedicine.medscape.com/article/324096-overview.Google Scholar
14Perry, L. Diagnosis and management of dysphagia after stroke. Clin Geriatr 2001; 4: 32–33.Google Scholar
15Ratnaike, RN, Hathley, S. Dysphagia in older persons, Part I. Oropharyngeal Dysphagia. Clin Geriatr 2002. Available at: http://www.mmhc.com/engine.pl?Station=MHCtemplate=gull-htmlid=559.Google Scholar
16Knol, W, Van Marum, RJ, Jansen, PAF, Souverein, PC, Schobben, AFAM, Egberts, ACGP. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 2008; 56: 661–66Google Scholar
17DiSario, JA, Foutch, PG, Sanowski, RA. Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc 1990; 36: 257–60.CrossRefGoogle Scholar
18Mold, JW, Reed, LE, Davis, AB, Allen, ML, Decktor, DL, Robinson, M. Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastroenterol 1991; 86: 965–70.Google Scholar
19Haag, S, Holtmann, G. Reflux disease and Barrett's esophagus. Endoscopy 2003; 35: 112–17.Google Scholar
20Koerfer, J et al. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Ann Intern Med 1990; 120: 653–62.Google Scholar
21Rayner, CK, Horowitz, M. Changes in gastrointestinal motor and sensory function associated with ageing. In Principles of Geriatric Medicine, 4th edn, Pathy, J (ed). Chichester: John Wiley, 2006; pp. 357–70.Google Scholar
22Cook, DJ, Rook, GA. Priorities in perioperative geriatrics. Anesth Anlg 2003; 96: 1823–36.Google Scholar
23McCue, J. Pneumonia in the elderly, special considerations, in special population. Postgrad Med 1993; 94, 39–51.Google Scholar
24Sahn, SA. Continuous lateral rotational therapy and nosocomial pneumonia. Chest 1991; 99: 1263–67.Google Scholar
25Wright, JR. Pulmonary surfactant: a front line of lung host defence. J Clin Invest 2003; 10: 1453–55.Google Scholar
26American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388–416.Google Scholar
27Bartlett, JG.Nursing Home-Acquired Pneumonia. Merck Manual, available at: http://www.merck.com/mmpe/sec05/ch052/ch052d.html.Google Scholar
28Ranes, JL, Gordon, S, Arroliga, AC. Hospital-Acquired, Health Care-Associated, and Ventilator-Associated Pneumonia, available at: http://www.clevelandclinicmeded.com/health-care-associated-pneumonia.Google Scholar
29Marrie, TJ. Pneumoccocal pneumonia: a continuously evolving disease. J Infect 1992; 24: 247–55.Google Scholar
30Sopena, N, Sabria, M; the Neunos 2000 Study Group. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest 2005; 127: 213–21.Google Scholar
31Marrie, TJ. Community-acquired pneumonia in the elderly. Clin Infect Dis 2000; 31: 1066–78.Google Scholar
32Riquelme, R, Torres, A, el-Ebiary, M, Mensa, J, Estruch, R, Ruiz, M, Angrill, J, Soler, N. Community-acquired pneumonia in the elderly, clinical and nutritional aspects. Am J Respir Crit Care Med 1997; 156: 1908–14.Google Scholar
33Fein, AM. Pneumonia in the elderly: special diagnostic and therapeutic considerations. Med Clin North Am 1994; 78: 1015–103.Google Scholar
34Ruiz, M, Ewig, S, Marcos, MA, Martinez, JA, Arancibia, F, Mensa, J, Torres, A. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 1999; 160: 397–405.Google Scholar
35Jeng, A, Karnangar, N, Sharma, S. Pneumonia, Viral. Pneumonology. Available at: http://emedicine.medscape.com/article/300455-overview.Google Scholar
36McDowell, Anderson W. Pneumonia. In Merck Manual of Geriatrics. Available at: http://www.merck.com/mkgr/mmg/sec10/ch76/ch76a.jsp.Google Scholar
37Kuhn, GJ. Pneumonia, Viral. Available at: http://emedicine.medscape.com/article/808013-overview.Google Scholar
38Ewig, S, Torres, A. Is Chlamydia pneumoniae an important pathogen in patients with community-acquired pneumonia? Eur Respir J 2003; 21: 741–42.Google Scholar
39Oba, Y, Guntu, VP. Chlamydial Pneumonias. Available at: http://emedicine.medscape.com/article/297351-overview.Google Scholar
40Schneeberger, PM, Dorigo-Zetsma, JW, van der Zee, A, van Bon, M, van Opstal, JL. Diagnosis of atypical pathogens in patients hospitalized with community-acquired respiratory infection. Scand J Infect Dis 2004; 36: 269–73.Google Scholar
41Cunha, BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect 2006; 12: 12–24.Google Scholar
42Wester, AL, Blaasaas, KG, Bruun, WT. Is the concentration of C-reactive protein in bacteraemia associated with age? Available at: http://www.immunityageing.com/content/5/1/8.Google Scholar
43Smith, RP, Lipworth, BJ, Cree, IAA. C-reactive protein. A clinical marker in community-acquired pneumonia. Chest 1995; 108: 1288–91.Google Scholar
44Hansson, LO, Hedlund, JU, Ortqvist, AB. Sequential changes of inflammatory and nutritional markers with community-acquired pneumonia. Scand J Clin Lab Invest 1997; 57: 111–18.Google Scholar
45Chalmers, KD, Singanayagan, A, Hill, AT. C-reactive protein is an independent predictor of severity in community-acquired pnemonia. Am J Med 2008; 121: 2189–225.Google Scholar
46Krüger, S, Ewig, S, Marre, R, Papassotiriou, J, Richter, K, von Baum, H, Suttorp, N, Welte, T; CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31: 349–55.Google Scholar
47Ebrega, E, Ewig, S, Torres, A et al. Clinical diagnosis of ventilator-associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 1999; 54: 867–73.Google Scholar
48Pugin, J, Auckenthaler, R, Mili, N, Janssens, JP, Lew, PD, Suter, PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic blind bronchoalveolar lavage fluid. Am Rev Respir Dis 1991; 143: 1121–29.Google Scholar
49Singh, N, Rogers, P, Atwood, CW, Wagener, M, Yu, VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. Am J Respir Care Med 2000; 162: 505–11.Google Scholar
50Feldman, C. Pneumonia in the elderly. Med Clin North Am 2001; 85: 1441–145.Google Scholar
51British Thoracic Society Community-Acquired Pneumonia in Adults Guideline Group. Guideline for management of community-acquired pneumonia in adults: update 2009. Thorax 2009; 6 (suppl III): 1–55.Google Scholar
52Andreo, F, Domingues, J, Ruiz, J et al. Impact of rapid urine antigen tests to determine the etiology of community-acquired pneumonia. Resp Med 2006; 100: 884–91.Google Scholar
53Dowel, SF. Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis 2001; 33: 492–503.Google Scholar
54Lim, WS, Van Der Eerden, MM, Laing, R, Boersma, WG, Karalus, N, Town, GI, Lewis, SA, Macfarlane, JT. Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377–82.Google Scholar
55Fine, MJ, Auble, TE, Yealy, DM, Hanusa, BH, Weissfeld, LA, Singer, DE, Coley, CM, Marrie, TJ, Kapoor, WN. A prediction rule to identify low risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243.Google Scholar
56Rello, J, Paiva, A, Baraibar, J. International conference for the development of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest 2001; 120: 955–70.Google Scholar
57Celis, R, Torres, A, Gatell, JM, Almela, M, Rodriquez-Roisin, R. Nosocomial pneumonia: A multivariate analysis of risk and prognosis. Chest 1988; 93: 318–24.Google Scholar
58Barta, T, Foltán, V, Gajdošík, J, Hájková, M, Chovan, L, Kralinský, K, Líšková, A, Profant, M, Purgelová, A, Trupl, J. Zásady racionálnej antibiotickej liečby respiračných infekcií (Principles of antibiotic treatment of respiratory infections). Available at: http://www.mediforum.sk/pdf/ATB_liecba01.pdf.Google Scholar
59Sharma, S. Pneumonia, Viral. Available at: http://www.emedicine.medscape.com/article/300455-overview.Google Scholar
60Constans, WC, Guo, SS, Vellas, B, Guioz, Y. Protein energy malnutrition in elderly medical patients. J Am Geriatr Soc 1992; 40: 263–68.Google Scholar
61Kalman, D, Barriere, SL. Review of the pharmacology, pharmacokinetics, and clinical use of cephalosporins. Tex Heart Inst J 1990; 17: 203–15.Google Scholar
62Coresh, J, Byrd-Holt, D, Astor, BC, Briggs, JP, Eggers, PW, Lacher, DA, Hostetter, TH. Chronic kidney disease awareness, prevalence and trends among US adults, 1999 to 2000. J Am Soc Nephrol 2005; 16: 180–88.Google Scholar
63Stevens, LA, Nolin, TD, Richardson, MM, Feldman, HI, Lewis, JB, Rodby, R, Townsend, R, Okparavero, A, Zhang, YL, Schmid, CH, Levey, AS; Chronic Kidney Disease Epidemiology Collaboration. Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations. Am J Kidney Dis 2009; 54: 33–42.Google Scholar
64Göb″oová, M. Interakcie, antibiotík. (Interactions of antibiotics). Available at: http://www.antibiotika.sk/interakcie_antibiotik.phpGoogle Scholar
65Langšádl, L et al. Výskyt infekcií vyvolaných toxínom Clostridium difficile vôžkových zariadeniach FNSP Bratislava. (Prevalence of infections caused by Clostridium difficile in Bratislava Faculty Hospital). Interná Med 2009; 5: 269–73.Google Scholar
66Poh, LL, Timothy, MS, Barkham, LML, Dimatatac, F, Tamuno, A, Ang, B. Increasing incidence of Clostridium difficile-associated disease in Singapore. Emerg Infect Dis 2008; 14; available at: http://www.cdc.gov/EID/content/14/9/1487.htm.Google Scholar
67Asensio, A, Vaque-Rafart, J, Calbo-Torrecillas, F, Gestal-Otero, JJ, López-Fernández, F, Trilla-Garcia, A, Canton, R; EPINE Working Group. Increasing rates of Clostridium difficile infection (CDI) among hospitalised patients, Spain 1999–2007. Euro Surveill 2008; 13: 18943.CrossRefGoogle ScholarPubMed
68Zillberg, MD. Clostridium difficile-related hospitalizations among US adults, 2006. Emerg Infect Dis 2009; 15: 122–24.Google Scholar
69Woodhead, M. Pneumonia in the elderly. J Antimicrob Chemotherapy 1994; 34: 85–92.Google Scholar
70Mouton, CP, Bazaldua, O, Pierce, B, Espinoza, DV. Common infections in older adults. Am Fam Physician 2001; 63: 257–68.Google Scholar
71Halm, EA, Fine, MJ, Marrie, TJ, Coley, CM, Kapoor, WN, Obrosky, DS, Singer, DE. Time to clinical stability in patients hospitalized with community-acquired pneumonia. JAMA 1998; 279: 1452–57.CrossRefGoogle Scholar
72Daifuku, R, Movahhed, H, Fotheringham, N, Bear, MB, Nelson, S. Time to resolution of morbidity: an endpoint for assessing the clinical cure of community-acquired pneumonia. Respir Med 1996; 90: 587–92.Google Scholar
73Menendez, R, Torres, A. Treatment failure in community-acquired pneumonia. Chest 2007; 132: 1348–55.Google Scholar
74Menéndez, R, Torres, A, Zalacaín, R, Aspa, J, Martín, Villasclaras JJ, Borderías, L, Benítez, Moya JM, Ruiz-Manzano, J, Rodríguez de Castro, F, Blanquer, J, Pérez, D, Puzo, C, Sánchez Gascón, F, Gallardo, J, Alvarez, C, Molinos, L; Neumofail Group. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax 2004; 59: 960–65.Google Scholar
75Tillotson, JR, Finland, M. Bacterial colonization and clinical superinfections of the respiratory tract complicating antibiotic treatment of pneumonia. J Infect Dis 1969; 119: 597–62.Google Scholar
76Örtquist, AS, Hammers-Berggren, Kalin M. Respiratory tract colonization and incidence of secondary infection during hospital treatment of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 1990; 9: 725–31.Google Scholar
77Garcia, Vidal C, Carratala, J. Early and late treatment failure in community-acquired pneumonia. Semin Respir Crit Care Med 2009; 30: 154–60.Google Scholar
78Arancibia, F, Ewig, S, Martinez, JA, Ruiz, M, Bauer, T, Marcos, MA, Mensa, J, Torres, A. Antimicrobial treatment failures in patients with community-acquired pneumonia. Am J Respir Crit Care Med 2000; 162: 154–60.Google Scholar
79Hoffman, J, Cetron, MS, Farley, MM et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med 1995; 333: 481–86.Google Scholar
80Plouffe, JF, Breiman, RF, Facklam, RR. Bacteremia with Streptococcus pneumoniae: Implications for therapy and prevention. JAMA 1996; 275: 194–98.Google Scholar
81Sims, RV, Steinmann, WC, McConville, JH et al. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med 1988; 108: 653–57.Google Scholar
82Gross, PA, Hermogenes, AW, Sacks, HS, Lau, J, Levandowski, RA. The efficacy of influenza vaccine in elderly persons: A meta-analysis and review of the literature. Ann Intern Med 1995; 123: 518–27.Google Scholar
83Jackson, ML, Nelson, JC. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study. Lancet 2008; 372: 398–405.Google Scholar
84DeRiso, AJ 2nd, Ladowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial repiratory infection and nonprophylactic systemic antibiotic prophylaxis in patients undergoing heart surgery. Chest 1996; 109: 1556–61.Google Scholar
85Heyland, DK, Drover, JW, MacDonald, S, Novak, F, Lam, M. Effect of postpyloric feeding on gastro-esopahgeal regurgitation and pulmonary micro-aspiration: results of a randomized controlled trial. Crit Care Med 2001; 29: 1495–501.Google Scholar
86Schallom, L, Metheny, NA, Stewart, J, Schnelker, R, Ludwig, J, Sherman, G, Taylor, P. Effect of frequency of manual turning on pneumonia. Am J Crit Care 2005; 14: 476–78.Google Scholar
87Staudinger, T, Bojic, A, Holzinger, U, Meyer, B, Rohwer, M, Mallner, F, Schellongowski, P, Robak, O, Laczika, K, Frass, M, Locker, GJ. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med 2010; 38: 486–90.Google Scholar