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

, Winthrop University Hospital, Mineola, NY


Medscape General Medicine. 1998;1(3) 

In This Article

Prognostic Indicators

Community-acquired pneumonia. The strongest predictive criteria of mortality in community-acquired pneumonia in the general population are BUN greater than 20 mg/dL, respiratory rate greater than 30 breaths per minute, and diastolic blood pressure less than 60mmHg. If two of these criteria are present on admission, mortality is increased up to 21-fold.[30]

Guidelines to help classify the severity of community-acquired pneumonia were first developed by the British Thoracic Society and have since been validated.[30,35,36] One of these studies has also shown that the initial assessment performed by medical staff often underestimates the severity of illness in as many as 21% of patients.[36]

Other predictors of mortality include age greater than 65, PaO2 less than 7.3 kPa (PaO2 less than 55mmHg), AST level greater than 57mmol/L, reduced peripheral perfusion, and respiratory rate greater than 30 breaths/minute.[37]

These clinical measurements (respiratory rate, blood pressure, blood urea nitrogen, and mental status) can and should be used to evaluate elderly patients admitted to the hospital with community-acquired pneumonia.