title: Influence of age on symptoms at presentation in patients with community-acquired pneumonia.
abstract: BACKGROUND
  Advanced age has become a well-recognized risk factor for death in patients with pneumonia. It may also be associated with reduced symptom reporting, raising the possibility that diagnosis and treatment may be delayed in older patients.
  
  
  OBJECTIVE
  To evaluate the association between age and the presenting symptoms in patients with community-acquired pneumonia.
  
  
  METHODS
  This study was conducted at inpatient and outpatient facilities at 3 university hospitals, 1 community hospital, and 1 staff-model health maintenance organization. Patients included adults (age > or = 18 years) with clinical and radiographic evidence of pneumonia, who were able to complete a baseline interview. The presence of 5 respiratory symptoms and 13 nonrespiratory symptoms were recorded during a baseline patient interview. A summary symptom score was computed as the total number of symptoms at presentation.
  
  
  RESULTS
  The 1812 eligible study patients were categorized into 4 age groups: 18 through 44 years (43%), 45 through 64 years (25%), 65 through 74 years (17%), and 75 years or older (15%). For 17 of the 18 symptoms, there were significant decreases in reported prevalence with increasing age (P < .01). In a linear regression analysis, controlling for patient demographics, comorbidity, and severity of illness at presentation, older age remained associated with lower symptom scores (P < .001).
  
  
  CONCLUSIONS
  Respiratory and nonrespiratory symptoms are less commonly reported by older patients with pneumonia, even after controlling for the increased comorbidity and illness severity in these older patients. Recognition of this phenomenon by clinicians and patients is essential given the increased mortality in elderly patients with pneumonia.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Metlay
authors.forename: R
authors.initials: R
authors.lastname: Schulz
authors.forename: Y H
authors.initials: YH
authors.lastname: Li
authors.forename: D E
authors.initials: DE
authors.lastname: Singer
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: C M
authors.initials: CM
authors.lastname: Coley
authors.forename: L J
authors.initials: LJ
authors.lastname: Hough
authors.forename: D S
authors.initials: DS
authors.lastname: Obrosky
authors.forename: W N
authors.initials: WN
authors.lastname: Kapoor
authors.forename: M J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D017714:Community-Acquired Infections / Q000209:etiology* / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index