COMMUNITY-ACQUIRED PNEUMONIA IN THE ELDERLY - CLINICAL AND NUTRITIONAL ASPECTS

Community-acquired pneumonia (CAP) in the elderly has a different clin ical presentation than CAP in other age groups. Confusion, alteration of functional physical capacity, and decompensation of underlying illn esses may appear as unique manifestations. Malnutrition is also an ass ociated feature of CAP in this population. We undertook a study to ass ess the clinical and nutritional aspects of CAP requiring hospitalizat ion in elderly patients (over 65 yr of age). One hundred and one patie nts with pneumonia, consecutively admitted to a 1,000-bed teaching hos pital over an 8-mo period, were studied (age: 78 +/- 8 yr, mean +/- SD ). Nutritional aspects and the mental status of patients with pneumoni a were compared with those of a control population (n = 101) matched f or gender, age, and date of hospitalization. The main symptoms were dy spnea (n = 71), cough (n = 67), and fever (n = 64). The association of these symptoms with CAP was observed in only 32 patients. The most co mmon associated conditions were cardiac disease (n = 38) and chronic o bstructive pulmonary disease (COPD) (n = 30). Seventy-seven (76%) epis odes of pneumonia were clinically classified as typical and 24 as atyp ical. There was no association between the type of isolated microorgan ism and the clinical presentation of CAP, except for pleuritic chest p ain, which was more common in pneumonia episodes caused by classical m icroorganisms (p = 0.02). This was confirmed by a multivariate analysi s (relative risk [RR] = 11; 95% confidence interval [CI]: 1.7 to 65; p = 0.0099). The prevalence of chronic dementia was similar in the pneu monia cohort (n = 25) and control group (n = 18) (p = 0.22). However, delirium or acute confusion were significantly more frequent in the pn eumonia cohort than in controls (45 versus 29 episodes; p = 0.019). On ly 16 patients with pneumonia were considered to be well nourished, as compared with 47 control patients (p = 0.001). Kwashiorkor-like malnu trition was the predominant type of malnutrition (n = 65; 70%) in the pneumonia patients as compared with the control patients (n = 31; 31%) (p = 0.001). The observed mortality was 26% (n = 26). Pleuritic chest pain is the only clinical symptom that can guide an empiric therapeut ic strategy in CAP (typical versus atypical pneumonia). Both delirium and malnutrition were very common clinical manifestations of CAP in ou r study population.