Diagnosis and treatment of pneumonia in the nursing home.

Risk factors, diagnosis, ethical considerations, and treatment of pneumonia in a nursing home setting are summarized. Risk factors for pneumonia include age-associated changes, co-morbid conditions, declining general health, and iatrogenic factors. Diagnosis can be challenging in geriatric residents because of atypical presentations and complex underlying diseases. Key features of presentation include rhonchi and confusion. An increased respiratory rate can be a sensitive indicator for pneumonia. Ethical dilemmas include identifying a resident's wishes for treatment in the event of an acute illness and the decision on whether to relocate the resident to an acute care facility. Decisions are based on available resources, medical stability of the resident, unimpeded access to a hospital, and the resident's well-informed decision. The common etiologic pathogen(s) of nursing-home-acquired pneumonia reflect a mixture between community-acquired and hospital-acquired pathogens. Multiple pharmacologic interventions are available, as well as supportive measures including oxygen therapy and hydration. Preventive measures are utilized to decrease the incidence of further infection.