COMMUNITY-ACQUIRED PNEUMONIA IN OLD-AGE - A PROSPECTIVE-STUDY OF 91 PATIENTS ADMITTED FROM HOME

Objective: to characterize the background, aetiology, clinical course and outcome of community-acquired pneumonia (CAP) in elderly compared with younger patients. Design: a 1 year prospective study. Setting: a university hospital in southern Israel. Participants: ninety-one patie nts over 65 years who were hospitalized from their homes with CAP: The se patients were compared with a reference group of 54 CAP patients, a ged 55-64 years. Measurements: an intensive work-up (primarily serolog ical) to identify the aetiological causes of CAP. The age groups were compared in terms of variables related to CAP. Results: the proportion with pneumococcal infection, the most common aetiology for CAP increa sed from 29.6% in the 55-64-year group through 45.6% in the 65-74-year group; up to 57.8% in the 75+ group (P = 0.019). Chlamydia pneumoniae was identified as the aetiological agent in 26.4% of elderly patients . Mortality in patients greater than or equal to 75 years was 20% and was significantly higher than in the two younger age groups (P = 0.019 ). The leucocyte count was significantly higher among the elderly grou p (P = 0.013) and the serum urea concentration was higher in patients 75 years and older (P = 0.025). The proportion of patients treated wit h antibiotics before admission decreased with increasing age (P = 0.02 6). Conclusions: CAP has more serious clinical and abnormal laboratory features in the elderly than younger patients, particularly in those over 75. In independent elderly people, the pneumococcus is the most c ommon causative agent for CAP but other agents, particularly C. pneumo niae, are common. Initial antibiotic treatment for these patients shou ld therefore include a macrolide.