Background: Community-acquired pneumonia (CAP) is one of the leading causes of mortality in the elderly. Additionally, the elderly population is increasing and an even more dramatic upward trend in the ‘very elderly’ subgroup is projected over the next several years. This research study was designed to compare characteristics, manifestations and outcomes between the elderly (65-84) and very elderly (85+).
Methods: Patients aged 65+ with CAP admitted to Good Samaritan or Bethesda North Hospital in fiscal year 2013 were included in this cohort study. Patients who were immuno-compromised or had healthcare-associated CAP were excluded from the study. CAP was defined as a new or changing pulmonary infiltrate with new or increased cough, fever over 37.8 C, or changes in WBC. Patients were categorized as elderly (65-84) or very elderly (85+). Univariate analyses, including chi-square and t-test, were used to compare the two age groups.
Results: Overall, 152 patients (70%) were elderly and 65 patients (30%) were very elderly. The elderly patients had more risk factors compared to the very elderly patients. Nineteen percent of the elderly patients were current smokers compared to 8% of the very elderly patients (p=0.04). Additionally, 68% of the elderly patients were not vaccinated for pneumonia compared to 52% of the very elderly patients (p=0.05). Over half of the elderly population (54%) had COPD compared to only 28% of the very elderly population (p<0.001). In terms of manifestations, the heart rate of the elderly (95.4) was significantly higher than the heart rate of the very elderly (85.4) (p=0.001). There were no differences in patient outcomes, which included mortality, ICU admission, readmission, length of stay, and length of IV therapy between the elderly and very elderly.
Conclusions: The very elderly experienced similar outcomes when compared to the elderly patients with CAP, and besides heart rate, basic clinical findings were also the same. The similarity between the two groups suggests evaluation and treatment of CAP does not need to be adjusted for the very elderly, possibly due to the healthier lifestyle that this group maintains.