Pneumonia in the elderly.

The population is aging gradually in France, and pneumonia is the most comm on infectious condition in the elderly. Predisposing factors include age-re lated factors (immunological alterations, comorbid conditions and their tre atments) and local factors of which the most common is repeated aspiration of food. Symptoms are often considered atypical in elderly subjects, with n eurologic or abdominal signs sometimes being more prominent than respirator y signs. S. Pneumoniae is the agent most often responsible for community-ac quired pneumonia in free-living elderly patients, whereas anaerobes and gra m-negative rods predominate in institutionalized patients; a third category is nosocomial pneumonia. The prognosis is poor, with half the unfavorable outcomes being ascribable to the pneumonia itself and half to the comorbid conditions. Drug dosages and galenic forms should be appropriate for elderl y subjects and selected according to the identified or suspected causative organism. Treatments used by consensus are almost the same from one country to the next. Amoxicillin alone or with clavulanic acid is the first-line d rug in free-living patients. In institutionalized patients, the high freque ncy of aspiration pneumonia makes the amoxicillin-clavulanic acid combinati on the treatment of choice. Most cases of nosocomial pneumonia in patients admitted for acute symptoms are due to gram-negative rods or staphylococci.