Pneumonia in the elderly. Factors related with the mortality during the episode and after the discharge

Pneumonia in the elderly (PIE) is a growing disease that causes great morbidity and mortality with frequent admissions to hospital and increasing health costs. The objective of our study was yo analyze the characteristics of PIE in an internal medicine hospital ward, the influence of quality of life (Katz index and scale of Karnofsky) on its evolution and after the discharge and the factors of poor prognosis during the episode of PIE and throughout the ambulatory follow-up. All the patients suffering from PIE admitted to the internal medicine ward of our hospital during a two years period were included in the study (125). Five of them were referred from geriatric centers. Mean age was 77.9 years (range = 65-95). The most frequent chronic disease was COPD (53.6%) and 10.4% were taking oral corticosteroids. We studied the association of several factors laboratory, clinical and radiological with the evolution of PIE and after discharge. Patients rated high on the indicators of quality of life used (78.4% scored 5 or greater on the Katz index and 76% scored 80 or greater on the scale of Karnofsky) and their comorbidity was low (44% lesser than or equal to 1 and 6.4% greater than or equal to 5). Fever above 38 C was recorded in 40% of cases. Mean APACHE score was 12.8. 21.6% patients had pleural effusion and 20% had multilobar involvement. Overall mortality was 8.8% (11 patients). Fifteen patients suffered major complications during admission. One hundred patients out of the 114 who survived the episode of PIE were followed up on an ambulatory basis. Thirty of those died within 12 months after discharge. In our study, a poorer quality of life and a higher APACHE score were related to a greater mortality during the episode of PIE. After hospital discharge, a greater mortality was associated with a poor quality of life, comorbidity and low concentrations of albumin.