Comprehensive management of pneumonia in older patients
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| Title: | Comprehensive management of pneumonia in older patients |
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| Authors: | Putot, Alain, Garin, Nicolas, Rello, Jordi, Prendki, Virginie |
| Contributors: | Institut Català de la Salut, [Putot A] Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont-blanc, Sallanches, France. [Garin N] Department of Internal Medicine, Riviera-Chablais Hospitals, Switzerland. Department of Medicine, Geneva University Hospitals, Switzerland. [Rello J] IMAGINE, UR-UM 107, University of Montpellier, Division of Anaesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France. Medicine Department, Universitat Internacional de Catalunya, Spain. Grup de Recerca Clínica/Innovació en la Pneumònia i Sèpsia, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Prendki V] Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland, Vall d'Hebron Barcelona Hospital Campus |
| Source: | Scientia Scientia. Dipòsit d'Informació Digital del Departament de Salut instname |
| Publisher Information: | Elsevier BV, 2025. |
| Publication Year: | 2025 |
| Subject Terms: | Complications, Other subheadings::Other subheadings::/therapeutic use, Otros calificadores::Otros calificadores::/uso terapéutico, DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::adulto::anciano, NAMED GROUPS::Persons::Age Groups::Adult::Aged, Persones grans, Other subheadings::Other subheadings::/diagnosis, 618.97, Otros calificadores::Otros calificadores::/diagnóstico, Diagnosis, Pneumònia - Tomografia, Pneumonia, Bacterial, Medicaments antibacterians - Ús terapèutic, Humans, Pneumònia - Diagnòstic, Aged, Aged, 80 and over, Malalties bacterianes, ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::neumonía bacteriana, DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Pneumonia, Bacterial, SARS-CoV-2, Prevention, Pneumònia - Tractament, COVID-19, Pneumonia, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::interpretación de imágenes asistida por ordenador::tomografía computarizada por rayos X, Anti-Bacterial Agents, Treatment, Community-Acquired Infections, CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents, COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antibacterianos, Older people, Tomography, X-Ray Computed, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Image Interpretation, Computer-Assisted::Tomography, X-Ray Computed |
| Description: | Pneumonia is a leading cause of death and functional decline in the older population. Diagnosis of pneumonia conventionally includes the presence of respiratory signs and symptoms, systemic signs of infection and a radiographic demonstration of lung involvement. Pneumonia diagnosis in the very old patient is compromised by atypical and unspecific presentation, resulting in a high proportion of false positive diagnosis. Chest radiograph is frequently of low quality and inconclusive in older patients. Computed tomography scan and chest ultrasound may provide valuable diagnostic confirmation in uncertain cases. Bacterial pneumonia has been mainly studied, but viruses, among which influenza, SARS-CoV-2, and respiratory syncytial virus, are increasingly recognized as major players. The decision to treat pneumonia is usually based on a triple assessment of diagnostic probability, disease severity and the general assessment of the patient (frailty, comorbidities, place of living, and goals of care). Antimicrobial treatment is probabilistic, targeting common pathogens. The optimal antibiotic treatment depends on epidemiological data, setting of acquisition, comorbidities, risk factors for methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or aspiration pneumonia, and severity. Recent controlled trials have demonstrated the non-inferiority of short regimen in non-severe community acquired pneumonia, even in older individuals and a five-day antibiotic treatment is recommended in case of clinical improvement. Pneumonia management in older patients requires a comprehensive approach, including control of comorbidities (particularly cardiovascular), nutritional support, rehabilitation, and prevention of aspiration. Finally, pneumonia may be a pre-terminal event in many patients, requiring advanced-care planning and prompt instauration of palliative management. |
| Document Type: | Article |
| File Description: | application/pdf |
| Language: | English |
| ISSN: | 0953-6205 |
| DOI: | 10.1016/j.ejim.2025.02.025 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/40021428 http://hdl.handle.net/11351/13046 https://archive-ouverte.unige.ch/unige:184133 https://doi.org/10.1016/j.ejim.2025.02.025 |
| Rights: | CC BY |
| Accession Number: | edsair.doi.dedup.....7dcdfadb01d763e8799ad0382e5dd6eb |
| Database: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Pneumonia is a leading cause of death and functional decline in the older population. Diagnosis of pneumonia conventionally includes the presence of respiratory signs and symptoms, systemic signs of infection and a radiographic demonstration of lung involvement. Pneumonia diagnosis in the very old patient is compromised by atypical and unspecific presentation, resulting in a high proportion of false positive diagnosis. Chest radiograph is frequently of low quality and inconclusive in older patients. Computed tomography scan and chest ultrasound may provide valuable diagnostic confirmation in uncertain cases. Bacterial pneumonia has been mainly studied, but viruses, among which influenza, SARS-CoV-2, and respiratory syncytial virus, are increasingly recognized as major players. The decision to treat pneumonia is usually based on a triple assessment of diagnostic probability, disease severity and the general assessment of the patient (frailty, comorbidities, place of living, and goals of care). Antimicrobial treatment is probabilistic, targeting common pathogens. The optimal antibiotic treatment depends on epidemiological data, setting of acquisition, comorbidities, risk factors for methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or aspiration pneumonia, and severity. Recent controlled trials have demonstrated the non-inferiority of short regimen in non-severe community acquired pneumonia, even in older individuals and a five-day antibiotic treatment is recommended in case of clinical improvement. Pneumonia management in older patients requires a comprehensive approach, including control of comorbidities (particularly cardiovascular), nutritional support, rehabilitation, and prevention of aspiration. Finally, pneumonia may be a pre-terminal event in many patients, requiring advanced-care planning and prompt instauration of palliative management. |
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| ISSN: | 09536205 |
| DOI: | 10.1016/j.ejim.2025.02.025 |