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

, Winthrop University Hospital, Mineola, NY


Medscape General Medicine. 1998;1(3) 

In This Article

Features of Pneumonia

Clinical presentation of pneumonia in the elderly can vary from the classic to the occult nonpulmonary. Recent studies[27,28,29,30,31,32,33] have confirmed Olser's past suspicions that "In old age pneumonia may be latent, coming on without chill. The cough and expectoration is slight, physical signs ill-defined and changeable, and the constitutional symptoms out of all proportion. Of fever there may be none. Fever is higher in healthy adults than in old persons and drunkards." As noted above, the clinical manifestations of pneumonia in the elderly are often less intense than those in younger patients.[27,28,29] Productive cough and chest pains are less frequent among the elderly with pneumonia than they are in younger patients.[30,31,32,33] It appears that the intensity of pneumonia symptoms decline in a linear fashion as age increases.[30,34] Advanced age, cognitive impairment at baseline, and baseline functional impairment correlate with the absence of pneumonia symptoms. In contrast, delirium or cognitive impairment, leukocytosis, and progression of changes on chest radiograph after admission are more common in the elderly.[30,34]