TY - JOUR T1 - How can we improve the management and outcome of pneumonia in the elderly? JF - European Respiratory Journal JO - Eur Respir J SP - 12 LP - 14 DO - 10.1183/09031936.00039908 VL - 32 IS - 1 AU - V. Brito AU - M. S. Niederman Y1 - 2008/07/01 UR - http://erj.ersjournals.com/content/32/1/12.abstract N2 - Community-acquired pneumonia (CAP) is a common illness, with increased mortality in certain populations, particularly the elderly and those with severe illness 1–3. The association between advanced age and mortality is well known; Sir William Osler's infamous view was that pneumonia was the “friend of the aged” that often allowed patients with advanced illness to die peacefully. In spite of this viewpoint, it remains uncertain whether ageing itself adds to this mortality risk or whether the adverse outcomes of CAP in the elderly are the consequence of other factors, some of which might be modified, such as the presence of comorbid illnesses and the therapies required to manage them, or the delays in the diagnosis of pneumonia that result from indistinct clinical presentations in the elderly. Fry et al. 1 studied the data of the National Hospital Discharge Survey and found that in older hospitalised patients with pneumonia, at least one underlying medical condition was reported in most medical records. Marston et al. 2 studied hospitalised patients with CAP for 1 yr in two counties in Ohio, USA. Amongst the 2,776 patients studied, the incidence and mortality of pneumonia in the elderly was much higher than in younger populations. Kaplan et al. 3 reported the 1-yr mortality of elderly patients admitted for CAP and observed that beyond the immediate 12% in-patient mortality rate, there was a 1-yr death rate of >40%, raising the question as to whether pneumonia is a surrogate marker of other types of serious illness in the elderly. Numerous factors could contribute to the high mortality rate of CAP in the elderly. It is more difficult to diagnose pneumonia in the elderly than in young patients because the usual clinical clues for its diagnosis might be absent at the time of onset of illness. Riquelme et … ER -