[Pneumonia in the elderly]

In the aged, pneumonia is associated with considerable morbidity and mortality. As a consequence of ageing, decreased mobility, underlying illnesses and medication, especially the host defense mechanisms in the respiratory tract may become deficient. The kind of micro-organism that causes the infection depends on whether the patient lives at home or whether he is institutionalised (nursing home, skilled nursing facility, hospital). Pneumonia in patients at home is mainly caused by pneumococci, whereas in institutionalised patients also other micro-organisms, especially Gram-negative bacteria are the cause. The diagnosis is often difficult due to the lack of symptoms and signs in the aged patient. An important sign is tachypnea. For the choice of anti-microbial therapy the question whether the patient acquired the infection at home or in an institution is crucial, as is the question, whether the patient has recently used anti-microbial drugs. Finally, therapy differs in patients that produce sputum and in those who do not.