Pneumonia is not only a major cause of death for elderly persons, but also imposes substantial personal morbidity and burdens on the health care system. Timely, accurate diagnosis and therapy depend on recognition of important differences in the pathogenesis of pneumonia according to the settings in which it occurs. Active elderly persons living in the community, institutionalized seniors with “nursing home pneumonia,” and those with hospital-acquired infections have different microbial causes of their respiratory infections that, together with altered host defenses and iatrogenic factors, dramatically influence outcomes. The presence of other common medical illnesses in older persons obscures the clinical presentations of pneumonia, predisposes to respiratory infection, and adversely influences prognosis. These clinical relationships and the variability and vulnerability of individual patients underlie largely empiric, setting-specific antimicrobial therapy. Whenever possible, prevention of this devastating illness is essential.
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