Skip to main content

Advertisement

SpringerLink
Log in

Community-Acquired Pneumonia in Older Adults

  • Infectious Diseases in the Elderly (KS Kaye and D Kaye, Section Editors)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Community-acquired pneumonia (CAP) is a common disorder with significant morbidity and mortality, particularly for older adults. Risk factors include comorbid conditions commonly found in older patients as well as immunocompromising conditions such as steroid use or administration of anti-TNF agents. While Streptococcus pneumoniae remains the most common cause of CAP in older patients, the microbiology of pneumonia differs somewhat from that of young adults with increased incidence of Staphylococcus aureus and gram-negative bacilli (especially for patients who are residents of nursing homes). The classic features of infections such as fever may not be present in older patients. Antimicrobial therapy is similar to that of younger patients and based on recent guidelines; however, there is an increased need to adjust doses based on the pharmacokinetics of the older population. Prevention includes administration of preventive vaccines and control of comorbid conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. File TM. Community-acquired pneumonia. Lancet. 2003;362:1991–2001.

    Article  PubMed  Google Scholar 

  2. Loeb M. Pneumonia in older persons. Clin Infect Dis. 2003;37:1335–9.

    Article  PubMed  Google Scholar 

  3. Wunderink RG, Waterer GW. Community-acquired pneumonia. N Engl J Med. 2014;370:1863. Excellent recent review of community-acquired pneumonia iniated by clinical vignette of older patient.

    CAS  PubMed  Google Scholar 

  4. Wroe PC, Finkelstein JA, Ray GT, Linder JA, Johnson KM, Rifas-Shiman S, et al. Aging population and future burden of pneumococcal pneumonia in the United States. J Infect Dis. 2012;205:1589–92.

    Article  PubMed  Google Scholar 

  5. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002;165:766–72.

    Article  PubMed  Google Scholar 

  6. Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis. 2004;39:1642–50.

    Article  PubMed  Google Scholar 

  7. Fry AM, Shay DK, Holman RC, Curns AT, Anderson LJ. Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002. JAMA. 2005;294:2712–9.

    Article  CAS  PubMed  Google Scholar 

  8. File TM Jr., Tan JS. Pneumonia in older adults: reversing the trend. In: Jama. Edited by; 2005:2760-2763. vol 294.

  9. Donowitz GR, Cox HL. Bacterial community-acquired pneumonia in older patients. Clin Geriatr Med. 2007;23:515–34. vi.

    Article  PubMed  Google Scholar 

  10. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61:1–117.

    PubMed  Google Scholar 

  11. Millett ER, Quint JK, Smeeth L, Daniel RM, Thomas SL. Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study. PLoS One. 2013;8:e75131.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Palmu AA, Saukkoriipi A, Snellman M, Jokinen J, Torkko P, Ziegler T, et al. Incidence and etiology of community-acquired pneumonia in the elderly in a prospective population-based study. Scand J Infect Dis. 2014;46:250–9.

    Article  PubMed  Google Scholar 

  13. Cascini S, Agabiti N, Incalzi RA, Pinnarelli L, Mayer F, Arca M, et al. Pneumonia burden in elderly patients: a classification algorithm using administrative data. BMC Infect Dis. 2013;13:559. Thorough assessment of 3 classifications of pneumonia in a large population of older adults using electronic health records. Stratifies incidence and compares risk factors and etilogies.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Ruhnke GW, Coca-Perraillon M, Kitch BT, Cutler DM. Marked reduction in 30-day mortality among elderly patients with community-acquired pneumonia. Am J Med. 2011;124:171–178.

  15. Welte T, Kohnlein T. Global and local epidemiology of community-acquired pneumonia: the experience of the CAPNETZ Network. Semin Respir Crit Care Med. 2009;30:127–35.

    Article  PubMed  Google Scholar 

  16. Bewick T, Sheppard C, Greenwood S, Slack M, Trotter C, George R, et al. Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia. Thorax. 2012;67:540–5.

    Article  PubMed  Google Scholar 

  17. Griffin MR, Grijalva CG. Hospitalizations after a decade of pneumococcal vaccination. N Engl J Med. 2013;369:1662–3.

    Article  CAS  PubMed  Google Scholar 

  18. Klausen HH, Petersen J, Lindhardt T, Bandholm T, Hendriksen C, Kehlet H, et al. Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system. Respir Med. 2012;106:1778–87.

    Article  CAS  PubMed  Google Scholar 

  19. Tichopad A, Roberts C, Gembula I, Hajek P, Skoczynska A, Hryniewicz W, et al. Clinical and economic burden of community-acquired pneumonia among adults in the Czech Republic, Hungary, Poland and Slovakia. PLoS One. 2013;8:e71375.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Juthani-Mehta M, De Rekeneire N, Allore H, Chen S, O'Leary JR, Bauer DC, et al. Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. J Am Geriatr Soc. 2013;61:1111–8.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sato R, Gomez Rey G, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged >/=50 years. Appl Health Econ Health Policy. 2013;11:251–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yu H, Rubin J, Dunning S, Li S, Sato R. Clinical and economic burden of community-acquired pneumonia in the Medicare fee-for-service population. J Am Geriatr Soc. 2012;60:2137–43. Based on A Medicare database more than 65,000 patients with CAP were identified. An estimated 1.3 million CAP cases and 74,000 CAP-related deaths were found, with an economic burden of $13 billion annually.

    PubMed  Google Scholar 

  23. Song JH, Thamlikitkul V, Hsueh PR. Clinical and economic burden of community-acquired pneumonia amongst adults in the Asia-Pacific region. Int J Antimicrob Agents. 2011;38:108–17.

    PubMed  Google Scholar 

  24. Takahashi K, Suzuki M, le Minh N, Anh NH, Huong LT, Son TV, et al. The incidence and aetiology of hospitalised community-acquired pneumonia among Vietnamese adults: a prospective surveillance in Central Vietnam. BMC Infect Dis. 2013;13:296.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Organization WH. The Top 10 Causes of Death. Edited by; 2014.

  26. Faverio P, Aliberti S, Bellelli G, Suigo G, Lonni S, Pesci A, et al. The management of community-acquired pneumonia in the elderly. Eur J Intern Med. 2014;25:312–9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther. 1998;20:820–37.

    Article  CAS  PubMed  Google Scholar 

  28. Thomas Wasser P, Jingbo Yu M, Joseph Singer M, Bernard Tulsi M, Reiko Sato P. Long-Term Cost Consequences of Community-Acquired Pneumonia in Adults. Edited by. Am J Pharm Benefits. 2013;5:e66–72.

    Google Scholar 

  29. Ma HM, Tang WH, Woo J. Predictors of in-hospital mortality of older patients admitted for community-acquired pneumonia. Age Ageing. 2011;40:736–41.

    Article  PubMed  Google Scholar 

  30. Yoo KH, Yoo CG, Kim SK, Jung JY, Lee MG, Uh ST, et al. Economic burden and epidemiology of pneumonia in Korean adults aged over 50 years. J Korean Med Sci. 2013;28:888–95.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Polverino E, Torres A, Menendez R, Cilloniz C, Valles JM, Capelastegui A, et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013;68:1007–14.

    Article  PubMed  Google Scholar 

  32. Nakagawa N, Saito Y, Sasaki M, Tsuda Y, Mochizuki H, Takahashi H. Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia. Geriatr Gerontol Int. 2014;14:362–71.

    Article  PubMed  Google Scholar 

  33. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013;68:1057–65. A review of 33 studies of CAP in Europe. The presence of comorbid conidtions, such as chronic respiratory or heart diseases, cerebrovascular disease, and chronic renal or liver disease all increased the risk of CAP in the elderly.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Loeb M, Neupane B, Walter SD, Hanning R, Carusone SC, Lewis D, et al. Environmental risk factors for community-acquired pneumonia hospitalization in older adults. J Am Geriatr Soc. 2009;57:1036–40.

    Article  PubMed  Google Scholar 

  35. Xiao K, Su LX, Han BC, Yan P, Yuan N, Deng J, et al. Analysis of the severity and prognosis assessment of aged patients with community-acquired pneumonia: a retrospective study. J Thorac Dis. 2013;5:626–33.

    PubMed Central  PubMed  Google Scholar 

  36. Pieralli F, Vannucchi V, Mancini A, Grazzini M, Paolacci G, Morettini A, et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Intern Emerg Med. 2014;9:195–200.

    Article  PubMed  Google Scholar 

  37. El Solh AA, Pietrantoni C, Bhat A, Bhora M, Berbary E. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis. 2004;39:474–80.

    Article  PubMed  Google Scholar 

  38. El-Solh AA. Nursing home acquired pneumonia: approach to management. Curr Opin Infect Dis. 2011;24:148–51.

    Article  PubMed  Google Scholar 

  39. Liapikou A, Polverino E, Cilloniz C, Peyrani P, Ramirez J, Menendez R, et al. A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia. Respir Care. 2014;59:1078–85.

    Article  PubMed  Google Scholar 

  40. Ewig S, Klapdor B, Pletz MW, Rohde G, Schutte H, Schaberg T, et al. Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study. Thorax. 2012;67:132–8.

    Article  PubMed  Google Scholar 

  41. Ma HM, Wah JL, Woo J. Should nursing home-acquired pneumonia be treated as nosocomial pneumonia? J Am Med Dir Assoc. 2012;13:727–31.

    Article  PubMed  Google Scholar 

  42. Ugajin M, Yamaki K, Hirasawa N, Kobayashi T, Yagi T. Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients. Clin Interv Aging. 2014;9:267–74.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Umeki K, Tokimatsu I, Yasuda C, Iwata A, Yoshioka D, Ishii H, et al. Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia. Respirology. 2011;16:856–61.

    Article  PubMed  Google Scholar 

  44. Nicolle LE, Mubareka S, Simor A, Liu B, McNeil S, Lewis D, et al. Variation in mortality rates among long-term care facilities for residents with lower respiratory tract infection. Infect Control Hosp Epidemiol. 2008;29:754–9.

    Article  CAS  PubMed  Google Scholar 

  45. Cilloniz C, Polverino E, Ewig S, Aliberti S, Gabarrus A, Menendez R, et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest. 2013;144:999–1007. The authors assessed the influence of age and comorbidities on microbial patterns in elderly patients. Mortality in the elderly was mainly driven by the presence of comorbidities and potential for drug-resistant pathogens.

    Article  PubMed  Google Scholar 

  46. Liu YF, Gao Y, Chen MF, Cao B, Yang XH, Wei L. Etiological analysis and predictive diagnostic model building of community-acquired pneumonia in adult outpatients in Beijing, China. BMC Infect Dis. 2013;13:309.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Klapdor B, Ewig S, Pletz MW, Rohde G, Schutte H, Schaberg T, et al. Community-acquired pneumonia in younger patients is an entity on its own. Eur Respir J. 2012;39:1156–61.

    Article  PubMed  Google Scholar 

  48. El-Solh AA, Sikka P, Ramadan F, Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med. 2001;163:645–51.

    Article  CAS  PubMed  Google Scholar 

  49. Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33:1065–79. A summary of 33 studies published from Europe. There was a trend for S. pneumoniae, H influenzae and respiratory viruses to be more frequent in elderly patients, whereas M pneumoniae was more common in patients less than 65 years of age.

  50. Mandell LA, Bartlett JG, Dowell SF, File Jr TM, Musher DM, Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2003;37:1405–33.

    Article  PubMed  Google Scholar 

  51. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.

    Article  CAS  PubMed  Google Scholar 

  52. Metlay JP, Schulz R, Li YH, Singer DE, Marrie TJ, Coley CM, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157:1453–9.

    Article  CAS  PubMed  Google Scholar 

  53. File TMJ. CAP: Improving outcome by decreasing hospitalization, an editorial. File TM Jr. J Resp Dis. 2000;21:530–1.

  54. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.

    Article  CAS  PubMed  Google Scholar 

  55. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. File Jr TM. New diagnostic tests for pneumonia: what is their role in clinical practice? Clin Chest Med. 2011;32:417–30.

    Article  PubMed  Google Scholar 

  57. DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371:635–45.

    Article  PubMed  Google Scholar 

  58. ACIP Recommends Routine PCV13 Immunization for Adults 65 and Older. Edited by; 2014.

  59. Janssens JP. Pneumonia in the elderly (geriatric) population. Curr Opin Pulm Med. 2005;11:226–30.

    PubMed  Google Scholar 

  60. McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005;28:810–5.

    Article  PubMed  Google Scholar 

  61. Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly : epidemiology, diagnosis and management. Drugs Aging. 2005;22:115–30.

    Article  PubMed  Google Scholar 

  62. Yoshino A, Ebihara T, Ebihara S, Fuji H, Sasaki H: Daily oral care and risk factors for pneumonia among elderly nursing home patients. In: Jama. Edited by; 2001. p 2235-2236. vol 286.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Thomas R. Breen declares that he has no conflict of interest.

Thomas M. File Jr. has received research support through grants from Pfizer and Cempra, and has served on scientific advisory boards for Cubist, Tetraphase, Nabriva, Durata, and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, Summa Health System, 75 Arch St. Suite G1, Akron, OH, 44304, USA

    Thomas R. Breen

  2. Division of Infectious Disease, Summa Health System, 75 Arch St. suite 506, Akron, OH, 44304, USA

    Thomas M. File Jr.

  3. Infectious Disease Section, Northeast Ohio Medical University, Rootstown, OH, USA

    Thomas M. File Jr.

Authors
  1. Thomas R. Breen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas M. File Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas M. File Jr..

Additional information

This article is part of the Topical Collection on Infectious Diseases in the Elderly

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Breen, T.R., File, T.M. Community-Acquired Pneumonia in Older Adults. Curr Geri Rep 4, 51–59 (2015). https://doi.org/10.1007/s13670-014-0112-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-014-0112-7

Keywords

Search

Navigation