Pneumonia in the elderly [Le polmoniti nella popolazione geriatrica]

The pneumonia is an inflammatory reaction to infectious agents or their products, that represents the fourth cause of death in the oldest patients. With respect to the youngest population the pneumonia in the elderly subjects is more severe, requires often hospitalisation, is characterized by a longer length-of-stay and characterized by greater mortality. Together with the age the greater risk factor for its development is the comorbidity that conditions the appearance of complications and the same mortality. In the elderly the annual incidence varies and it is considered that about 2% of the elderly residents in assistential structures is affected from pneumonia. In 30-50% of pneumonias no pathogen agent is identifiable, even though the identified colonization of gram-positive bacteria and gram-negative potentially pathogen is more frequent in the elderly with respect to the youngest population. The most frequent pathogen agents responsible of pneumonias in the elderly are: The Streptococcus pneumoniae, Bacilli Gram-negative, Bacteria Anaerobes, the Haemophilus influences, the Legionella and some virus. In the elderly subjects signs and symptoms of pneumonia are often atypical characterized, beyond cough with production of secretion, from confusion, lethargy, delirium and deterioration of the general condition without fever. For the etiologic diagnosis the secretion cultural examination and the haemocolture would be routinely performed. The chest radiography is the gold standard for patients evaluation. In the treatment of patients affected by pneumonia it is necessary to carry out a global evaluation of the patient considering age, the presence of a pre-existing pathology, a previous antibiotic therapy ect., because such elements are able to change the prognosis of the patient. For the prevention, an essential role, together with the nutritional appearance, is put on the flu and pneumococcic vaccination. The therapy is based on the correct use of the antibiotics, and on the oxygentherapy, the parenteral nutrition, the cardiovascular therapy, etc.