Bronchopneumonia and Respiratory Failure

Bronchopneumonia is the commonest certified cause of death over the age of 70 years. In approximately 1 in 3 admissions to acute geriatric units the diagnosis of chest infection is made. The prevalence of pneumonia in the general population is difficult to estimate as it is such a common disease and for the most part is treated in the community. Death rates from pneumonia have declined dramatically over the last 30–40 years, the decline pre-dating the introduction of antibiotics which accelerated the underlying trend. When the mortality rates are examined in relation to age, however, deaths from pneumonia in the elderly continue to rise. Age specific death rates for pneumonia closely follow a Gompertz relationship, i.e. the logarithm of the number of deaths per hundred thousand members of the population plotted against age is a linear relationship, implying that there is an exponential increase in mortality from pneumonia with increasing age. The mortality from pneumonia over the age of 70 is about one thousand per hundred thousand population. In middle age the mortality remains under one hundred per hundred thousand. The mortality rate is greater in males but because of the excess number of females in the elderly population, cases of pneumonia are more likely to be seen in elderly women. All these facts point to pneumonia being a common and serious problem in the management of elderly patients. It has to be recognized, however, that bronchopneumonia is commonly a terminal event in the context of the increasing prevalence of chronic and disabling diseases seen in old age.