Pneumonia in the elderly.

Pneumonia, including community-acquired, long-term care facility-associated, and nosocomial infections, is a major cause of morbidity and mortality in the elderly. The aged with pneumonia often present with atypical features, including confusion, lethargy, and general deterioration of condition (so-called "silent infection"). Further investigations, such as a chest radiograph, are more frequently required for diagnosis, but even these results may be normal early in the course of infection, particularly in dehydrated patients. The elderly are more frequently hospitalized for pneumonia and have a greater need for intravenous therapy, longer hospital stay, more prolonged course, greater morbidity, and, ultimately, a poorer outcome. Yet in many studies it is not chronological age per se that impacts negatively on the manifestations of pneumonia in the elderly but rather the presence of comorbid illness. Antibiotic therapy remains the mainstay of therapy for pneumonia, and both community and hospital-based studies confirm the important positive impact of early appropriate empiric antibiotic therapy on outcome. Attention to nutrition and hydration, the use of pneumococcal and influenza vaccination, and a number of diverse procedures in the hospital setting may help limit the occurrence and impact of such infections.