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

, Winthrop University Hospital, Mineola, NY


Medscape General Medicine. 1998;1(3) 

In This Article

Pneumonia Resolution

Slow recovery and delayed resolution of radiographic infiltrates commonly occur in the setting of pneumonia in older individuals. Significant disability and reduced activity may be expected for months following lower respiratory tract infection. Factors such as age and serious comorbid illnesses, including diabetes mellitus, renal disease, or COPD, and pathogen virulence, influence recovery from pneumonia.[43,44] Increasing age, chronic obstructive lung disease, and alcohol abuse add to the likelihood of prolonged illness. In bacteremic pneumococcal pneumonia, the presence of comorbid illness identifies individuals whose chest radiographs are likely to be abnormal beyond 3 months.[44] Severe illness at presentation, multilobar involvement, smoking history, and persistent leukocytosis or fever also have been identified as factors which delay recovery.[43,44]

Infiltrates eventually dissipate. In general, 50% of patients with pneumococcal pneumonia have radiographic clearing at 5 weeks, the majority clearing in 2 to 3 months.[44] Bacteremia identifies a more severely ill group with 50% clearing at 9 weeks, and most clearing by 18 weeks.[44] A more recent report found that radiographic resolution in community-acquired pneumonia was most influenced by the number of lobes affected and the age of the patient at onset. Radiographic clearance of community-acquired pneumonia was shown to decrease by 20% per decade after age 20, and patients with multilobar infiltrates were found to take longer to clear than those with unilobar disease.[45]

The older the patient with pneumonia, the more likely resolution of radiographic infiltrates is to be delayed, especially if other comorbid illnesses are present. If both symptomatic and radiographic resolution are proceeding, albeit at a slow rate, then careful follow-up until complete resolution is sufficient. When symptoms and radiographic infiltrates persist, diagnostic testing including bronchoscopic evaluation, computer tomograph of the chest and lung biopsy are needed. Further diagnostic testing can determine the cause for nonresolving infiltrates, such as unusual pathogens (endemic fungi, tuberculosis, etc.), neoplasms, immunologic disorders that can mimic pneumonia (eg, Wegener's granulomatosis), and resistant bacterial pathogens.