R.A. Harrison, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.
T.J. Marrie, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.

Among older adults, aspiration pneumonia is associated with higher rates of morbidity and mortality than community-acquired pneumonia. Individuals admitted to acute care from continuing care facilities are at increased risk for aspiration pneumonia. Risk factor assessment forms a cornerstone in diagnosing aspiration pneumonia syndromes. Monitoring for timely clinical response to therapy and for potential complications is an important step in the care of patients with aspiration pneumonia. Further high-quality research is needed to better delineate the effects of risk factor modification on the incidence of aspiration pneumonia. Aiming to prevent aspiration pneumonia poses health care providers with an opportunity for ongoing development, study, and implementation of preventive strategies for older adults.
Key words: aspiration, pneumonia, older adults, geriatric, risk factor.

Mohammed Al Houqani, MBBS, Department of Medicine, University of Toronto, Toronto, ON.
Theodore K. Marras, MD, FRCPC, Attending Staff, Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital; Assistant Professor of Medicine, University of Toronto, Toronto, ON.

Long-term care-acquired pneumonia is a clinical syndrome of pneumonia that develops in a resident of a long-term care facility who has not been recently hospitalized. It is one of the leading causes of mortality and morbidity among the residents of long-term care facilities. Streptococcus pneumonia, Haemophils influenza, and Moraxella catarrhalis are the most frequently identified bacterial causative. Poor oral hygiene increases the risk of long-term care-acquired pneumonia. In this review, we discuss the risk factors, pathogenesis, etiology, management, and the preventive measures for long-term care-acquired pneumonia.
Key words: Long-term care, nursing home, health care facilities, pneumonia, fluoroquinolones.

Ashraf Alzaabi, MD, FRCPC, Respirology Fellow, University of Toronto, Toronto, ON.

Theodore K. Marras, MD, FRCPC, Respirologist, Toronto Western Hospital, University Health Network; Assistant Professor of Medicine, University of Toronto, Toronto, ON.

Community-acquired pneumonia (CAP) in the older adult is a common disease with significant mortality. This review focuses on the management of CAP, with specific reference to the older adult. Common etiologic organisms and organism-specific risk factors that tend to be associated with increasing age are presented. A systematic approach is described to help physicians decide on the best treatment site (ambulatory, long-term care facility, or acute care hospital). The rationale behind initial empiric antibiotic therapy and drug resistance are discussed. Recent guidelines for the selection of empiric antibiotic therapy are compared and a synthesis of guidelines for antibiotic selection and recommendations regarding parenteral to oral switch-therapy are presented. Guidelines are suggested to help the physician safely discharge the patient home.

Key words: pneumonia, management, older adults, guidelines, resistance.

Neil Fam, BSc, MSc

Pneumonia is a common and serious condition that claims over 6,000 lives in Canada annually. The elderly are particularly at risk, with individuals over 65 accounting for 50% of all pneumonia cases and 90% of deaths due to lower respiratory tract infection.¹ Indeed, elderly patients with pneumonia have a mortality rate 3-5 times that of young adults. A combination of factors contribute to the increased incidence of pneumonia in the elderly, including the presence of comorbid illness and the effects of aging on the lungs and immune system (see Age-related Changes to the Respiratory System Will Not Affect Healthy Elderly). Recent advances in our understanding of pneumonia have led to a re-evaluation of traditional approaches to the disease. This review outlines disease presentation, common pathogens and current diagnostic, treatment and preventive options in the care of elderly patients with pneumonia.

Michele Kohli, BSc, MSc

The persistence of influenza in the North American population has not been completely explained by epidemiologists.¹ During the last influenza season (1997-98), there were 5,148 laboratory confirmed cases of influenza in Canada (see Table 1).² The elderly population, those aged 65 years and above, are particularly susceptible to this disease. Over 95% of the deaths caused by influenza occur in this age group, in part, because of the higher prevalence of congestive heart failure and lung disease.¹ Last year, the occurrence of influenza peaked between January and March.² When the prevalence of influenza is high in a population, patients presenting with a febrile respiratory illness along with symptoms such as myalgia, headache, sore throat and cough are often diagnosed as having influenza.¹ However, the gold standard for diagnosis is laboratory detection of the virus in nasopharyngeal swabs.¹ The genes of the influenza virus mutate frequently, causing the antigenic molecules of the virus to change, resulting in the emergence of new viral sub-types. This process is known as antigenic drift. When human and swine or avian strains of influenza A recombine, the resulting new subtypes can cause pandemics.