Community-acquired pneumonia: diagnosis and therapy of older adults

Community-acquired pneumonia is a common problem in older adults and is associated with substantial morbidity and mortality. Diagnosis may be difficult, because signs of respiratory involvement may be absent and either constitutional or CNS symptoms may predominate. Elevated respiratory rate may be an important diagnostic clue. No specific pathogen is identified, and therefore empiric therapy is indicated in up to 50% of patients. The decision to hospitalize those over age 65 for parenteral antibiotic therapy is individualized. After 3 to 5 days of i.v. antibiotics oral therapy can be initiated upon favorable clinical response in the absence of proven metastatic foci of infection. Lack of response should prompt reassessment. Immunization with both the pneumococcal and viral influenza vaccines is indicated for most older patients. Discontinuation of smoking should also be encouraged.