AIDS-RELATED PNEUMOCYSTIS-CARINII PNEUMONIA IN OLDER PATIENTS

OBJECTIVE: To determine whether older age influences patterns of care and in-hospital mortality for persons hospitalized with AIDS-related P neumocystis carinii pneumonia (PCP). DESIGN: Retrospective chart revie w. PATIENTS/SETTING: Patients (2.174) with AIDS-related PCP in 96 hosp itals in five cities from 1987 through 1990. OUTCOME MEASURE: In-hospi tal mortality. MAIN RESULTS: Compared with younger patients, patients aged 50 years or older were less likely to have acquired HIV via intra venous drug use or homosexual contact (p = .0001). Older patients were more likely to have comorbid diseases (12% vs 4%; p = .0001), had mor e frequent neurologic findings an admission (19% vs 9%; p = .0001), an d scored higher on a PCP-specific severity-or-illness scale indicating more severe disease (p = .0001), Older patients had more intensive ca re unit: admissions and intubations (p = .0001). Patients aged 50 year s or older were less Likely to have a diagnosis of HIV mentioned in th eir progress notes during the first 2 days of. admission (75% vs 85%; p = .0001), less likely to receive PCP-specific therapy within the fir st 2 hospital days (58% vs 76%; p = .0001), and more likely to receive steroids (32% vs 22%; p = .0001). Older patients had a greater in-hos pital mortality (32% vs 18%; p = .0001). However, in logistic regressi on analysis with mortality as the outcome, the effect of older age was diminished when adjustments were made for insurance status, severity of illness, comorbidity, timely PCP therapy, and inpatient use of ster oids. CONCLUSIONS: Age differences in mortality for AIDS-related PCP m ay be explained by increased severity of presenting illness, underreco gnition of HIV, and delay in initiation of PCP-specific therapy. Physi cians may need to consider HIV-related infections for persons aged 50 years or older at risk of HN infection.