Pneumonias in the elderly patient. Risk factors and poor prognosis
Keywords:
pneumonia, comorbidity, geriatric assessment, risk factors, agedAbstract
Introduction: pneumonia, named by Sir William Osler “the captain of the hosts of men's death”, represents one of the main health problems in the world. Both the incidence and the mortality rate increase with age because in the geriatric patient there are diseases that increase the risk of pneumonia. In addition, due to their own health conditions and immune senescence, the probability of dying from this cause is very high.Objective: to study the main characteristics of pneumonia in the elderly and mainly the increased risk factors for developing it.
Methods: a prospective quantitative-qualitative research was carried out in 950 patients aged 60 years or older with a diagnosis of community-acquired pneumonia admitted to the “Arnaldo Milián Castro” Hospital, in Villa Clara Province, from January 2016 to December 2018 with the aim of determining the risk factors of community-acquired pneumonia in the elderly.
Results: the most frequent clinical manifestations were: fever, cough, decay, tachypnea and tachycardia, in various combinations. Smoking, chronic obstructive pulmonary disease, bronchial asthma, heart failure, diabetes mellitus and alcoholism were risk factors. Age was an independent prognostic factor associated with higher mortality, longer hospital stay and longer recovery time.
Conclusions: the most frequently found risk factors were smoking, alcoholism, chronic obstructive pulmonary disease, cancer, diabetes mellitus and heart failure.
Downloads
References
1.Aleaga Hernandez YY, Serra Valdes MA, Cordero López G. Neumonía adquirida en la comunidad: aspectos clínicos y valoración del riesgo en ancianos hospitalizados. Rev Cubana Salud Pública [Internet]. 2015 Sep [citado 22/03/2020];41(3):[aprox. 14 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662015000300003&lng=es
2.Feldman C. Pneumonia in the elderly. Clin in Chest Med [Internet]. 1999 Sep [citado 22/03/2020];20(3):[aprox. 11 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10516904/. https://doi.org/10.1016/s0272-5231(05)70236-7
3.Fein AM. Pneumonia in the elderly. Special diagnostic and therapeutic considerations. Med Clin North Am [Internet]. 1994 Sep [citado 22/03/2020];78(5):[aprox. 20 p.] Disponible en: https://pubmed.ncbi.nlm.nih.gov/8078366/. https://doi.org/10.1016/s0025-7125(16)30117-1
4.Montero Alcaraz JC. Guía-Itinerario formativo de la Unidad Docente de Medicina Familiar y Comunitaria [Internet]. Mataró: Consorci Sanitari del Maresme; 2020 [citado 22/03/2020]. Disponible en: https://www.csdm.cat/media/upload/arxius/r-d-i/docencia/formacio-sanitaria-especialitzada/GIFT-i-supervisio/MFiC_GIFT_2020.pdf
5.Rojas Pérez MM, Díaz de Villegas Reguera V, Sacramento Pedraza I, Rodríguez Marañón M, Martínez Rojas L, Delgado Pagán G. Mortalidad por enfermedades respiratorias en el adulto mayor. Evolución en un año. Acta Méd Centro [Internet]. 2016 [citado 29/03/2020];10(3):[aprox. 6 p.]. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/683/813
6.Murphy TF. Neumonías. En: Mandell, Douglas y Bennett. Enfermedades infecciosas. Principios y práctica. 9th Ed. [Internet]. España: Elsevier; 2020 [citado 29/03/2020]. Disponible en: https://www.elsevier.com/books/mandell-douglas-y-bennett-enfermedades-infecciosas-principios-y-practica/bennett/978-84-9113-499-2
7.Martínez-Vernaza S, Mckinley E, Soto MJ, Gualtero S. Neumonía adquirida en la comunidad: una revisión narrativa. Univ Med [Internet]. 2018 Sep-Dec [citado 29/03/2020];59(4):[aprox. 7 p.]. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S2011-08392018000400093. https://doi.org/10.11144/javeriana.umed59-4.neum
8.Prasad P, Bhat S. Clinicomicrobiological study of community-acquired pneumonia. Lung India [Internet]. 2017 Oct [citado 29/03/2020];34(5):[aprox. 7 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28869245/. https://doi.org/10.4103/lungindia.lungindia_89_17
9.Laurani H, Leivas J, Palacio R, Hortal Palma M. Carga de neumonía en adultos hospitalizados. An Fa Med [Internet]. 2018 [citado 29/03/2020];5(2):[aprox. 7 p.]. Disponible en: http://www.scielo.edu.uy/pdf/afm/v5n2/2301-1254-afm-5-02-86.pdf. http://dx.doi.org/10.25184/anfamed2018v5n2a3
10.Azevedo J. Metodologias qualitativas: análise do discurso. In: Esteves J, Azevedo J, editores. Metodologias qualitativas para as ciências sociais. Porto: Universidade do Porto; 1998 [Internet]. [citado 29/03/2020]. Disponible en: https://repositorio-aberto.up.pt/bitstream/10216/8902/2/4264.pdf
11.Artiles VL, Otero IJ, Barrios OI. Metodología de la investigación científica para las ciencias de la salud. XIV Ed. La Habana: Editorial Ciencias Médicas; 2008 [citado 29/03/2020]. Disponible en: http://files.sld.cu/ortopedia/files/2017/12/Metodolog%C3%ADa-de-la-investigaci%C3%B3n.pdf
12.Mandell, Douglas y Bennett’s Principles and Practice of Infectious Diseases. 8th Ed. [Internet]. Philadelphia: Saunders; 2014 [citado 29/03/2020]. Disponible en: https://www.elsevier.com/books/mandell-douglas-and-bennetts-principles-and-practice-of-infectious-diseases/bennett/978-1-4557-4801-3
13.Arshad H, Fasanya A, Cheema T, Singh AC. Acute pneumonia. Crit Care Nurs Q [Internet]. 2016 Jun [citado 29/03/2020];39(2):[aprox. 18 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26919676/. https://doi.org/10.1097/CNQ.0000000000000108
14.Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. Community-Acquired Pneumonia. New Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol [Internet]. 2010 Oct [citado 29/03/2020];46(10):[aprox. 16 p.]. Disponible en: https://www.archbronconeumol.org/en-community-acquired-pneumonia-new-guidelines-spanish-articulo-S1579212911600086. http://doi.org/10.1016/S1579-2129(11)60008-6
15.Morales A, Rosas GM, Yarce E, Paredes YV, Rosero M, Hidalgo A. Condiciones médicas prevalentes en adultos mayores de 60 años. Acta Med Colomb [Internet]. 2016 Mar [citado 29/03/2020];41(1):[aprox. 7 p.]. Disponible en: http://www.scielo.org.co/pdf/amc/v41n1/v41n1a06.pdf
16.Prevención, diagnóstico y tratamiento de neumonía adquirida en la comunidad. Guía de Evidencias y recomendaciones: Guía de Práctica Clínica [Internet]. México: IMSS; 2017 [citado 29/03/2020]. Disponible en: http://www.imss.gob.mx/sites/all/statics/guiasclinicas/234GER.pdf
17.Torres A, Menéndez R, Wunderink RG. Bacterial Pneumonia and Lung Abscess. Murray and Nadel's Textbook of Respiratory Medicine [Internet]. 2016 [citado 29/03/2020]:[aprox. 27 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152161/#. https://dx.doi.org/10.1016/B978-1-4557-3383-5.00033-6
18.Liu DS, Han XD, Liu XD. Current Status of Community Acquired neumonia in Patients with Chronic Obstructive Pulmonary Disease. Chin Med J (Engl) [Internet]. 2018 May [citado 29/03/2020];131(9):[aprpx. 5 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937318/. https://dx.doi.org/10.4103/0366-6999.230727
19.Gómez-Junyent J, Garcia-Vidal C, Viasus D, Millat-Martínez P, Simonetti A, Santos MS, et al. Clinical features, etiology and Outcomes of community acquired pneumonia in patients with chronic obstructive pulmonary disease. PLoS One [Internet]. 2014 Aug [citado 29/03/2020];9(8):[aprox. 4 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148341/. https://dx.doi.org/10.1371/journal.pone.0105854
20.Müllerova H, Chigbo C, Hagan GW, Woodhead MA, Miravitlles M, Davis KJ, et al. The natural history of community acquired pneumonia in COPD patients: A population database analysis. Respir Med [Internet]. 2012 Aug [citado 29/03/2020];106(8):[aprox. 10 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/22621820/. https://doi.org/10.1016/j.rmed.2012.04.008
21.Marrie TJ, Haldane EV, Faulkner RS, Durant H, Kwan C. Community-acquired pneumonia requiring hospitalization. Is it different in the elderly? J Am Geriatr Soc [Internet]. 1985 Oct [citado 29/03/2020];33(10):[aprox. 9 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/4045084/. https://doi.org/10.1111/j.1532-5415.1985.tb01775.x
22.Metlay JP, Schulz R, Li YH, Siger DE, Marrie TJ, Coley CM, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med [Internet]. 1997 Jul [citado 29/03/2020];157(13):[aprox. 7 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/9224224/
23.Sligl WI, Marrie TJ. Severe community-acquired pneumonia. Crit Care Clin [Internet]. 2013 Jul [citado 29/03/2020];29(3):[aprox. 9 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23830654/. https://doi.org/10.1016/j.ccc.2013.03.009
24.Corrêa RA, Costa AN, Lundgren F, Michelin L, Figueiredo MR, Holanda M, et al. 2018 recommendations for the management of community acquired pneumonia. J Bras Pneumol [Internet]. 2018 Oct [citado 29/03/2020];44(5):[aprox. 20 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467584/. http://dx.doi.org/10.1590/S1806-37562018000000130
25.Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med [Internet]. 2015 Jul [citado 29/03/2020];373(5):[aprox. 13 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728150/. https://doi.org/10.1056/nejmoa1500245
26.Chalmers JD. The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults. Semin Respir Crit Care Med [Internet]. 2016 Dec [citado 29/03/2020];37(6):[aprox. 9 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27960211/. https://doi.org/10.1055/s-0036-1592125
27.Taghizadieh A, Ala A, Rahmani F, Nadi A. Diagnostic Accuracy of Chest x-Ray and Ultrasonography in Detection of Community Acquired Pneumonia; a Brief Report. Emerg (Tehran) [Internet]. 2015 [citado 29/03/2020];3(3):[aprox. 3 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608340/
28.Karhu JM, Ala-Kokko TI, Ahvenjärvi LK, Rauvala E, Ohtonen P, Syrjälä HP. Early chest computed tomography in adult acute severe community-acquired pneumonia patients treated in the intensive care unit. Acta Anaesthesiol Scand [Internet]. 2016 Sep [citado 29/03/2020];60(8):[aprox. 8 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27272897/. https://doi.org/10.1111/aas.12749
29.Masiá M, Padilla S, Ortiz de la Tabla V, González M, Bas C, Gutiérrez F. Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial. PLoS One [Internet]. 2017 Apr [citado 29/03/2020];12(4):[aprox. 13 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398537/. https://dx.doi.org/10.1371/journal.pone.0175634
30.Fukuyama H, Yamashiro S, Kinjo K, Tamaki H, Kishaba T. Validation of sputum Gram stain for treatment of community-acquired pneumonia and healthcare-associated pneumonia: a prospective observational study. BMC Infect Dis [Internet]. 2014 Oct [citado 29/03/2020];14:[aprox. 12 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287475/. https://doi.org/10.1186/1471-2334-14-534
31.Ministério da Saúde. Manual de Procedimentos Básicos em Microbiologia Clínica para o Controle de Infecção Hospitalar [Internet]. Brasília: ANVISA/Ministério da Saúde; 2000 [citado 29/03/2020]. Disponible en: http://bvsms.saude.gov.br/bvs/publicacoes/manual_procedimentos_microbiologiaclinica_controle_infechospitalar.pdf
32.Rello J, Rodriguez R, Jubert P, Alvarez B. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis. Study Group for Severe Community-Acquired Pneumonia. Clin Infect Dis [Internet]. 1996 Oct [citado 29/03/2020];23(4):[aprox. 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8909834/. https://doi.org/10.1093/clinids/23.4.723
Downloads
Published
How to Cite
Issue
Section
License
Authors who have publications with this journal agree to the following terms:
- Authors will retain their copyright and assign to the journal the right of first publication of their work, which will simultaneously be subject to a Creative Commons License / Attribution-Noncommercial 4.0 International (CC BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.
- Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g., depositing it in an institutional repository or publishing it in a monographic volume) as long as the initial publication in this journal is indicated.
- Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).
15 junio 2025
