Community-acquired pneumonia in the elderly:: prognostic factors

The incidence and mortality rates of community-acquired pneumonia are far higher in the elderly than among younger populations. However, the explanation may lie in the presence of comorbidity rather than in age itself. We performed a retrospective study of 226 patients over the age of 65 years who were admitted to our hospital with a diagnosis of community-acquired pneumonia over a period of 36 months, with the objective of identifying factors predicting mortality and to describe clinical features. The patients' mean age was 78.71 (65-96) years. One hundred forty-two were men (63%) and 84 were women (37%). Upon admission, 27.4% showed signs of altered mental state. The crude mortality rate was 20.8%. Multivariate analysis demonstrated the following independent risk factors associated with higher mortality: serum creatinine > 1.2 mg/dL (RR = 13.93; 95% CI 8.14-16.08); patient previously bedridden (RR = 5.73; 95% CI 3.41-6.79), PaO2/FiO(2) < 200 (RR = 5; 95% CI 2.67-6.62) and neoplastic disease (RR = 4.08; 95% CI 1.96-5.24). The presence of chest pain was associated with a lower risk of mortality (RR = 0.11; 95% CI 0.01-0.54). Age itself was not a risk factor. We conclude that pneumonia in the elderly requires hospitalization and that it commonly presents with severe symptoms and high risk of mortality. Risk factors such as those identified in this study may help in the diagnosis and treatment of patients requiring special care.