title: The management of community-acquired pneumonia in the elderly.
abstract: Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy; University of Texas Health Science Center at San Antonio, TX, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Faverio
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy. Electronic address: stefano.aliberti@unimib.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: Department of Health Science, University of Milan Bicocca, Geriatric Clinic, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Suigo
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Lonni
authors.affiliation: Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pesci
authors.affiliation: University of Texas Health Science Center at San Antonio, TX, USA; South Texas Veterans Healthcare System Audie L. Murphy Division, San Antonio, TX, USA; Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), San Antonio, TX, USA.
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003693:Delirium / Q000175:diagnosis / Q000209:etiology; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D051346:Mobility Limitation; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000628:therapy; D018805:Sepsis / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute respiratory failure; Antibiotic treatment; Community-acquired pneumonia; Elderly; Functional status; Severity