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Community-acquired pneumonia: A risk assessment and clinical issues in hospitalized elderly patients

Abstract:

Introduction: community-acquired pneumonia affecting the older adults poses current and future challenges for the health care services.Objective: to characterize from the clinical and risk viewpoints the 60 years-old and over population admitted to the hospital and diagnosed with community-acquired pneumonia.Methods: retrospective and descriptive study conducted in 327 patients, who had been admitted to "Enrique Cabrera" general teaching hospital in 2012. The clinical variables and the risk indicators were all studied.Results: males and increase of the number of cases aged 70 years and over were predominant. The overall fatality rate was 18.7 %, which rose to 34.9 % from the 70 years-old age on. Chronic obstructive pulmonary disease, smoking, malnourishment,dementia and cardiovascular diseases were important risk factors. The hydroelectrolyte and acid/base alterations, acute respiratory distress and cardiac decompensation were the most frequent complications. The mostly used antimicrobial group was cephalosporins. The discharged patients recovered in 8 days whereas deaths occurred prior to eight days of application of treatment. Pneumonia severity indexes were not applied on admission to hospital.Conclusions: community-acquired pneumonia in the older adult must be addressed at the primary health care level. The prevention and health promotion actions have great importance. The initial diagnosis continues to be clinical whereas therapeutics is empirical. The support of practical clinical guidelines and of scales of prognosis improves the quality of medical care for these patients from the outpatient service at the physician's offices to admission at home care or at the hospital.