Differential diagnosis of types of pneumonia in the elderly

Pneumonia is the most common acute life-threatening infection in the USA, affecting >1% of the population each year and causing over 1.25 million hospitalizations. The incidence of pneumonia begins to increase after and above 65 years of age. About 3% of people over the age of 65 in the USA are likely to develop pneumonia every year, of which almost half will be hospitalized, resulting in more than 1.5 million hospitalizations per year [Sprung et al. Can J Anaeth. 53:1244-1257 (2006)]. About 7% of patients hospitalized with pneumonia die within 7 days and another 7% die within the next 30 days. Older adults make up the majority of patients treated in the healthcare system, largely due to their increased burden of chronic disease and their marked vulnerability such as functional and cognitive decline, falls, delirium and frailty. Pneumonia is one of the most common diseases in the elderly. Age-related changes in lung function cause a decrease in respiratory reserve during acute disease. Changes occur in pulmonary vascularization by increasing pulmonary vascular stiffness, vascular pressures and vascular resistance. Invasion by bacteria, viruses and other pathogens evokes systemic inflammation in response to the active immune system. Mechanisms of innate immunity include physical barriers and phagocytic cells such as neutrophils and macrophages, which destroy pathogenic bacteria. The elimination of bacteria occurs through the activation of phagocytes locally in the lung caused by the innate defense mechanism. Structural changes occur with aging;for example, there is a decrease in the beat and eyelash numbers, which reduces the clearance of debris and pathogens, with a consequent increase in the chances of infection. During the COVID pandemic, differential diagnosis is crucial for elderly patients. Much viral pneumonia with interstitial radiological patterns can be due to many different viruses (influenza A and B pneumonia, parainfluenza and coronavirus, mycoplasma) and many clinical and radiological models are actually mixed (bacterial and viral pneumonia). In this chapter, we discuss the differential diagnosis of elderly pneumonia. © Springer Nature Switzerland AG 2020.

The admission of older patients with COVID-19 in the general wards

Some criteria and selection tools are, in a general line, useful for recognition of all elderly patients with COVID-19 disease. Furthermore, many organisations may influence this criterion such as WHO, scientific medical society, a single government or health ministers and hospital management systems. In this chapter, we analysed the requirements for admission of the elderly patients in a general ward starting from triage evaluation using the new proposed tool for the selection. The necessity of a comprehensive geriatric assessment with a holistic vision has been not so crucial as in this period. © Springer Nature Switzerland AG 2020.