Bronchitis and Pneumonia

The incidence, morbidity, and mortality of both bronchitis and pneumonia are high in older adults and increase with age. The clinical manifestations of bronchitis and pneumonia in older adults may not be typical (e.g., cough, fever, dyspnea). Many older adults, particularly nursing home residents, may present with altered mental status and with or without fever. Obtaining a chest X-ray is often critical to make the distinction between the two clinical entities. Unique risk factors for pneumonia in older adults include multiple comorbidities (e.g., COPD, DM, CHF), poor oral hygiene, lack of vaccinations (e.g., S. pneumoniae, influenza), and swallowing difficulty. Empirical treatment decisions for pneumonia should be based on site of care. Recent information suggests that in-home therapy for community dwellers and therapy within the nursing home for long-term care residents is feasible with good outcomes in selected patients. Prevention strategies for pneumonia should be targeted towards providing vaccinations, improving oral hygiene, and improving swallowing difficulty.