The management of community-acquired pneumonia in the elderly

• Elderly patients hospitalized with pneumonia should be screened for delirium and mobility impairment.
• Choice of the antibiotic treatment must take into account pneumonia severity.
• Choice of the antibiotic treatment must consider risk factors for multi-drug resistant pathogens, aspiration and immunosuppression.
• Elderly patients may require personalized method to assess clinical stability.
• Influenza and pneumococcal vaccines should be recommended to pneumonia patients.

Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.