Pneumonia in Geriatric Patients

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

Abstract

In the elderly, the incidence and prevalence of pneumonia are four times higher than that of younger population. Age-associated changes are risk factors in the elderly for lower respiratory tract infections. Elderly patients have an excessive incidence of nosocomial pneumonia. The organisms affecting the elderly are the same as in the younger adults but with a different age-related distribution. In the elderly, the presenting features are often determined more by the host than by the specific organism causing the infection. The radiological appearances produced by the different organisms are variable and the radiological patterns are inconclusive, and there is no correlation between the pathological changes and the radiological appearances. The current approach to empirical management dwells on the type of patient (community or hospital) rather than the type of symptoms (typical or atypical). The antibiotic chosen should have an appropriate spectrum of the likely pathogens causing these infections and upon local resistance patterns of suspected organisms. The elderly have higher rates of hospitalization with a significant impact on morbidity and mortality.

Keywords

Nosocomial pneumonia Community-acquired pneumonia Pneumococcal vaccine Pneumonia severity index Curb-65 

References

  1. 1.
    Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis. 2004;4(2):112–124.CrossRefPubMedGoogle Scholar
  2. 2.
    Gross PA, Hermogenes AW, Sacks HS, Lau, Levandowski RA. The efficacy of influenza vaccine in the elderly persons. A meta-analysis and review of literature. Ann Intern Med. 1995;123:518–27.CrossRefPubMedGoogle Scholar
  3. 3.
    Stupka JE, Mortensen EM, Anzuelo A, Restripo M. Community acquired pneumonia in elderly patients. Aging Health. 2009;5:763–774.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Marrie TJ, Durrant H,Yates L. Community-acquired pneumonia requiring hospitalization: a 5-year prospective study. Rev Infect Dis. 1989;11:586–99.CrossRefPubMedGoogle Scholar
  5. 5.
    Marrie TJ. Epidemiology of community acquired pneumonia in the elderly. Semin respir Infect. 1990;5:260–288.PubMedGoogle Scholar
  6. 6.
    Scheld WM, Mandell GI. Nosocomial pneumonia: Pathogenesis and recent advances in diagnosis and therapy. Rev Infect Dis. 1991; 13 (suppl 9): S743-S751.CrossRefPubMedGoogle Scholar
  7. 7.
    Emori TG, Banerjee SN, Culver DH, Gaynes RP, Horan JC, Edwards JR, et al. Nosocomial infections in the elderly patients in the United States. 1986–1990. Am J Med. 1991;91 (S3B) :289S–293S7.CrossRefPubMedGoogle Scholar
  8. 8.
    Neralla S, Meyer KC. Drug treatment of pneumococcal pneumonia in the elderly. Drugs Aging. 2004;21(13):851–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Harkness GA, Bentley DW, Roghmann CJ. Risk factors for nosocomial pneumonia in the elderly. Am J Med. 1990;89(4):457–63.CrossRefPubMedGoogle Scholar
  10. 10.
    Rotstein C, Evans G, Born A,Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital acquired pneumonia and ventilator associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008;19(6):438.Google Scholar
  11. 11.
    Loeb M, McGreen A, McArthur M,Walter S, Simor AE. Risk factors for pneumonia and other lower tract infections in elderly residents of long term care facilities. Arch Intern Med. 1999;159:20:58–64.Google Scholar
  12. 12.
    Muder RR. Pneumonia in residents of long term care facilities, epidemiology, etiology, management and prevention. Am J Med. 1998;105:319–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian community acquired pneumonia Working Group. Canadian guidelines for the normal management of community acquired pneumonia: an evidence based update by the Canadian Infectious Disease Society and Canadian Thoracic Society. Clin Infect Dis. 2000;31:383–421.CrossRefPubMedGoogle Scholar
  14. 14.
    Koivula I, Sten M, Makel LP. Risk factors for pneumonia in the elderly. Am J Med. 1994;96(4):513–20.CrossRefGoogle Scholar
  15. 15.
    Hanson C,Weber DJ, Rutala WA. Risk factors for nosocomial pneumonia in the elderly. Am J Med. 1992;92(2):161–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Fleming CA, Balaguera HV, Craven DE. Risk factors for nosocomial pneumonia. Focus on prophylaxis. Med Clin North Am. 2000;65(6):1345–63.Google Scholar
  17. 17.
    Schaaf B, Liebau, Kurowski V, Droemann D, Dalhoff CK. Hospital acquired pneumonia with high-risk bacteria is associated with increased pulmonary matrix mettaloproteinase activity. BMC Pulmonary Med. 2008;8:12  https://doi.org/10.1186/1471-2466-8-12.CrossRefGoogle Scholar
  18. 18.
    Jones RN. Microbial etiology of hospital acquired bacterial pneumonia and ventilator associated bacterial pneumonia. Cli Infect Dis. 2010;51(suppl1):581–587.Google Scholar
  19. 19.
    Cunha BA. Pneumonia in the elderly. Clin Microbiol Infect. 2001;7:581–588.CrossRefPubMedGoogle Scholar
  20. 20.
    Johnson DR, Irving LB, Tumide JD. Community acquired pneumonia. Med J Aust. 2002;176(7):341–347.PubMedGoogle Scholar
  21. 21.
    Macfarlane JT, Miller AC, Smith WHR, Morris A, Rose DH. Comparative radiographic features of community-acquired Legionnaires’ disease, pneumococcal pneumonia, Mycoplasma pneumonia and psittacosis. Thorax. 1984;39:28–33.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ely EW. Pneumonia in the elderly: Diagnostic and Therapeutic Challenges. Infect Med. 1997;14(8): 643–654.Google Scholar
  23. 23.
    Groeneveld K, Eijik PP, Alphen LV, Jansen HM, Zanin HC. Haemophilus influenzae infections in patients with chronic obstructive pulmonary disease despite specific antibodies in serum and sputum. Am Rev Respir Dis. 1990;141:1316–1321.CrossRefPubMedGoogle Scholar
  24. 24.
    Wright PW, Wallace RJ Jr, Shepherd JR: A descriptive study of 42 cases of Moraxella catarrhalis pneumonia. Am J Med. 88 (Suppl 5A) 1990;2S–8S.CrossRefPubMedGoogle Scholar
  25. 25.
    Verghese A, Berk SL. Bacterial pneumonias in the elderly. Medicine 1983;62:271–285.CrossRefPubMedGoogle Scholar
  26. 26.
    Falco V, Fernandez de Sevilla T, Alegre J, Ferrer A, Martinez-Vasquez JM. Legionella pneumophila: a cause of severe community-acquired pneumonia. Chest. 1991;100: 1007–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Torres A, Serra-Batilles J, Ferrer A, Jimenez P, Celis R, Cobo E, et al. Severe community acquired pneumonias: epidemiology and prognostic factors. Am Rev Respir Dis. 1991;144:312–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Falsy AR, Walsh EC. Viral pneumonia in older adults. Clin Infect Dis. 2006;42(4):518–524.CrossRefGoogle Scholar
  29. 29.
    Augusto DK, Miranda LFJ-R, Cruz CEG, Pedros ERP. Comparative study of elderly inpatients clinically diagnosed with community acquired pneumonia with or without radiological confirmation. J bras pneumatol 2007;33(3).  https://doi.org/10.1590/S1806-371320070003007.
  30. 30.
    Marrie TJ. Community-acquired pneumonia in the elderly. Clin Infect Dis. 2000;31(4):1066–78).CrossRefPubMedGoogle Scholar
  31. 31.
    Riqueline R, Torres A, WI-Ebiary M, Mensa J, Estruch R, Ruiz M, et al. Community acquired pneumonias in the elderly. Am J Respr Crit Care Med. 1997;156:1908–14.CrossRefGoogle Scholar
  32. 32.
    Venkatesan P, Gladman J, Macfarlane JT, Barer D, Bernian P, Kinnear W, et al. A hospital study of community acquired pneumonia in the elderly. Thorax. 1990;45:254–258.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Harper C, Newton P. Clinical aspects of pneumonia in the elderly veterans. J Am Geriatr Soc. 1989;37:559872.CrossRefGoogle Scholar
  34. 34.
    Chan E, Fernandez E. The challenge of pneumonia in the elderly. J Respir Dis. 2001;22(3):139–148.Google Scholar
  35. 35.
    Feldman C. Pneumonia in the elderly. Med Clin North Am. 2001;859:1441–59.CrossRefGoogle Scholar
  36. 36.
    Fox A. Atypical presentation of geriatric infections. Geriatrics. 1988;43(5):58-9,63-4.Google Scholar
  37. 37.
    Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS,Weissfeld LA, et al. Prognosis and outcome of patients with community acquired pneumonia. JAMA. 1995;274:134–141.Google Scholar
  38. 38.
    Yoshikawa TT, Marrie T. Community acquired pneumonia in the elderly. Clin Infect Dis. 2000;31(4):1066–1078.CrossRefGoogle Scholar
  39. 39.
    Kuo CC, Jackson LA, Campbell LA, Grayston JT. Chlamydia pneumonia (TWAR). Clin Microbiol Rev. 1995;8(4):451–61.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Grayston JT, Campbell LA, Kuo CC, Mordhorst CH, Saikku P, Thom DH, et al. A new respiratory tract pathogen: Chlamydia pneumonia strain TWAR. J Infect Dis. 1990;161(4):618–25.CrossRefPubMedGoogle Scholar
  41. 41.
    Marrie TJ, Grayston JT, Wang SP, Kuo CC. Pneumonia associated with TWAR strain chlamydia. Ann Intern Med 1987;106(4):507–11.CrossRefPubMedGoogle Scholar
  42. 42.
    Ramirez JA, Ahkee S, Tolentino A, Miller RD, Summesgill JT. Diagnosis of Legionella pneumophila, Mycoplasma pneumoniae or Chlamydia pneumonia lower respiratory infection using the polymerase chain reaction on a single throat swab specimen. Diagn Microbiol Infect Dis. 1996; 24(1):7–14.CrossRefPubMedGoogle Scholar
  43. 43.
    Carratala J, Garcia-Vidal C. An update on Legionella. Curr Opin Infect Dis 2010;23(2):152–7 .CrossRefPubMedGoogle Scholar
  44. 44.
    Mcfarlane J, Case J. Radiological features of staphylococcal pneumonia in adults and children. Thorax. 1996;50(5):539–540.Google Scholar
  45. 45.
    Marrie TJ, Haldane D, Bezanson G Nosocomial Legionnaires’ disease. Clinical and radiological patterns. Can J Infect Dis. 1992;3(5):253–260.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    McConnell CT Jr, Plouffe JF, File TM, Mueller CF, Wong KH, Skelton SK, et al. Radiographic appearance of Chlamydia pneumonia (TWAR strain) respiratory infections. CBPIS Study Group. Community-based Pneumonia Incidence Study, Radiology. 1994;192(3):819–24.CrossRefPubMedGoogle Scholar
  47. 47.
    O’Connor S. Aspiration pneumonia and pneumonitis. Aust Prescriber 2003. http://www.australianprescriber.com/magazibne/26/1/14/7# retrieved 16 January 2014.
  48. 48.
    Nichol KL, Margolis KL, Wouremna J, von Sternberg T. Effectiveness of influenza vaccine in the elderly. Gerontology. 1996; 42:274–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Koivula I, Sten M, Leinonen M, Mejela PH. Clinical efficiency of pneumococcal vaccination in the elderly: a randomized single blind population based trial. Am J Med. 1997;103:289–94.CrossRefGoogle Scholar
  50. 50.
    Fine MJ, Smith MA, Carson CA, Meffe F, Sankey SS, Weissfeld LA, et al. Efficacy of pneumococcal vaccination in adults: a met-analysis of randomized controlled trials. Arch Intern Med. 1994;154:2666–71.CrossRefPubMedGoogle Scholar
  51. 51.
    Potter J, Scott HDJ, Roberts MA, Elder AG, O’Donnell B, Knight PV, et al. Influenza vaccination of health care workers in long term care reduces the mortality of elderly patients. J Infect Dis. 1997;1751–6.Google Scholar
  52. 52.
    Gross PA, Hermongenes AW, Sacks IM, Lau J, Levandowski RA. The efficacy of influenza vaccination in elderly patients: a meta-analysis and review of literature. Ann Inter Med. 1995;123:518–21.CrossRefGoogle Scholar
  53. 53.
    Fletcher MA, Lanfer DS, McIntosh ED, Cimino C, Malinoski FJ. Controlling invasive pneumococcal disease : Is vaccination of at risk group sufficient? Int J Clin Pract. 2006;60:450–6.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Chidiac C, Ader F. Pneumococcal vaccine in the elderly: a useful but forgotten vaccine. Aging Clin Exp Res2009;23(3): 222–8.CrossRefGoogle Scholar
  55. 55.
    Vila-Corcoles A. Advances in pneumococcal vaccines: what are the advantages for the elderly? Drugs Aging. 2007;24(10): 791–800.CrossRefPubMedGoogle Scholar
  56. 56.
    Lieberman D, Lierberman D. Community-acquired pneumonia in the elderly: a practical guide to treatment. Drugs Aging. 2000;17(2):93–105.CrossRefPubMedGoogle Scholar
  57. 57.
    Bodman KF. Current guidelines for the treatment of severe pneumonia and sepsis. Chemotherapy. 2005;51(8):227–55.CrossRefGoogle Scholar
  58. 58.
    Mandell LA, Wunderink RG, Anzuetto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America and American Thoracic Society consensus guidelines on the management of community acquired pneumonia. Clin Infect Dis. 2007;44:Suppl 2: 527–72.Google Scholar
  59. 59.
    Fine MJ, Auble TE, Yealy DM, Hannsa BH, Weisfeld LA, Singer DE, et al. A prediction rule to identify low risk patients with community acquired pneumonia. NEJM. 1997;336:243–250.CrossRefPubMedGoogle Scholar
  60. 60.
    Lim WS, van der Eerden MM, Laing R, Boerema 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.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Atlas SJ, Benzer TI, Browsky LH, Chang Y, Bumham DC, Metlay JP, et al. Safely increasing the proportion of patients with community acquired pneumonia treated as out-patients. Arch Intern Med. 1998;150:1350–1356.CrossRefGoogle Scholar
  62. 62.
    Macrolide Antibiotics: Chemistry, biology and practice, 2nd edition, Ed Satoshi Omura, 2002.Google Scholar
  63. 63.
    Australian Medicines Handbook 2004; Ed Rossi. ISBN 0–9578521–4-2. Chemistry, biology and practice, 2nd edition, Ed Satoshi Omura, 2002.Google Scholar
  64. 64.
    File TM. Treatment of community-acquired pneumonia in adults who require hospitalisation. Up to Date 2013. http://www.update.com/contents/treatment-of-community-acquired-pneumonia-in-a retrieved 17 January 2014.
  65. 65.
    Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies: A consensus statement, American Thoracic Society,November 1995. Am J Respir Crit Care Med. 1995;153:1072–1079.Google Scholar
  66. 66.
    Niederman MS, McComos JS, Unger AN, Kumar A, Popovian R. To cost of treating community acquired pneumonia. Clin Therapeut. 1998;20:820–827.CrossRefGoogle Scholar
  67. 67.
    Lim WS, Baudiuin SV, George RG, Hill AT, Jamieson C, Le Jeuse I, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64:iii1iii55.Google Scholar
  68. 68.
    Thompson WH. Bronchoalveolar carcinoma masquerading as pneumonia. Respir Care. 2004;49(11):1349–53.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

Personalised recommendations