Severe Pneumonia in the Elderly: Risks, Treatment, and Prevention

, Winthrop University Hospital, Mineola, NY


Medscape General Medicine. 1998;1(3) 

In This Article

Exposures and Risk Factors

Influenza pneumonia carries a higher incidence of morbidity and mortality in the elderly. Eighty percent of deaths in the most recent influenza epidemics occurred in those that are 65 years and older.[8] This is due to secondary respiratory infections occurring mostly in those with underlying comorbid illnesses. Patients with pneumonia who require hospitalization are more likely to develop complications, including acute respiratory distress syndrome (ARDS) and sepsis. They frequently need mechanical ventilation, resulting in a longer hospital stay.

Death rates from pneumococcal pneumonia are estimated to be 3 to 5 times greater in the elderly when compared with young adults.[1] It is estimated that one billion dollars per year are being spent on medical therapy to combat bacterial pneumonia in the elderly.

Contributing factors. It is difficult to determine to what extent senescent immune systems and concomitant illnesses contribute to pneumonia morbidity and mortality. Pneumonia has been associated with disability and severe comorbid illness, especially stroke, heart disease, and cancer.[9,10,11,12,13,14] The prevalence of these illnesses increases with age, and therefore, the elderly constitute a growing proportion of those at risk for pneumonia. The residents of chronic care institutions are often older with multiple comorbidities and disabilities. The incidence of pneumonia in these individuals is two to four times higher than a comparably aged noninstitutionalized individual.[15,16] The baseline incidence for pneumonia in those who are 75 years of age or older is 12/1000 annually, compared to 33/1000 per year in chronic care facilities.[16]

A number of studies have been done to determine the most likely independent risk factors for pneumonia. Marrie[2] found that alcoholism, (relative risk of 9), asthma, (relative risk of 4.2), immunosuppression, (relative risk of 3.1), heart disease, (relative risk of 1.9), institutionalization, (relative risk of 1.8) and age greater than 70, versus age 60 to 69, (relative risk of 1.5), had the strongest associations.