Studying Infection in the Elderly Physiopathology Clinical Symptoms and Causative Agents of Pneumonia

Jean-Paul Janssens

Pneumonia is a major threat to older individuals, with a high mortality. Aging is associated with a high rate of atypical clinical presentations (delirium, falls, incontinence, absence of fever, or cough) that may delay diagnosis. In this chapter, pneumonia will be discussed as a model of infection in older subjects. The normal age-related changes in respiratory physiology (such as decrease in forced expiratory volumes, respiratory muscle performance, and mucociliary clearance efficacy) and their relevance for explaining the higher susceptibility of older subjects to infection of the lower respiratory tract are detailed.

The main mechanisms leading to community-acquired and nursing-home acquired pneumonia are reviewed, with an emphasis on the importance of microaspiration, on risk factors such as colonization of the oro-pharyngeal flora by pathogenic organisms, and risk associated with artificial enteral feeding (naso-gastric tube or percutaneous gastrostomy). Immunosenescence and its relevance to lower respiratory tract is discussed elsewhere, in Chapter 65. Particularities of the clinical presentation of pneumonia in this age group, as well as prognostic indicators as to short-term and long-term outcome, are described. The most important pathogenic organisms and their epidemiological and clinical characteristics are reviewed, as well as more unusual organisms and their specificities. Alternative diagnoses to be considered in the situation of nonresponsive pulmonary infiltrates are also discussed.

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