title: [Death in geriatric pneumonia patients].
abstract: OBJECTIVE
  Pneumonia-associated deaths are the 4th leading cause of death in elderly people, and fatality tends to increase with age, especially after the age of 65. We aimed to further define convalescence in this patient population by examining the clinical characteristics of elderly pneumonia patients.
  
  
  METHODS
  We retrospectively examined the data of 292 patients aged 65 years or older who had died of pneumonia. Analysis was performed according to the guidelines for the management of pneumonia of the Japanese Respiratory Society (JRSGMP), which retrospectively classifies pneumonia into a community-acquired type (c type) and hospital-acquired type (h type). In the present study, there were 110 cases of c type and 182 cases of h type.
  
  
  RESULTS
  Among the factors that accurately predicted disease severity in the c type group, age was associated with the highest frequency (104; 94.5%). Furthermore, age was most frequently associated with a convalescence prediction factor in the h type group (150; 82.4%). The remaining factors collectively comprised approximately 50%. Except in mild cases in the c type group, deaths occurred in each of the disease severity groups for both pneumonia types. Dysphagia occurred in many cases in both groups, and in both pneumonia types the most common complication was dementia. In the h type group, cerebrovascular diseases were the second most common complication.
  
  
  CONCLUSIONS
  When assessing disease severity in elderly pneumonia patients, the JRSGMP may not allow accurate judgment of convalescence. It is very likely that dementia and cerebrovascular diseases cause dysphagia. Furthermore, very elderly patients are frequently at risk of developing aspiration pneumonia during treatment. For these reasons, it may be necessary to add the condition of a patient with these complications to the disease severity rating or convalescence prediction factor when considering the outcome of pneumonia in very elderly patients. It is necessary to consider all these factors when treating such episodes.
authors.affiliation: Department of Geriatric General Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University Faculty of Medicine.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ikeda
authors.forename: Miyoji
authors.initials: M
authors.lastname: Aiba
authors.forename: Takako
authors.initials: T
authors.lastname: Sakurai
authors.forename: Miki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Kwang Seok
authors.initials: KS
authors.lastname: Yang
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Isonuma
mesh_terms: D000367:Age Factors; D000368:Aged; D017714:Community-Acquired Infections / Q000401:mortality; D003428:Cross Infection / Q000401:mortality; D003704:Dementia / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index