My colleagues and I wholeheartedly agree with the wonderful letter by van der Steen et al. Our point in asking the question "is pneumonia still the old man's friend?" was to contrast our findings with an earlier study from Israel, which suggested that because mortality was much lower than in the past, pneumonia was "no longer the old man's friend."1 As van der Steen et al highlighted, we demonstrated that even if patients survived a hospitalization for community-acquired pneumonia, they remained at a considerably increased risk of death. In other words, we believed that community-acquired pneumonia was still a very serious condition with high associated mortality despite advances in therapeutic care. However, we completely agree that the deaths many of these patients incur may not be "friendly." Indeed, persons who return home after surviving community-acquired pneumonia may suffer considerably in the following months. Efforts to understand why these patients are at increased risk of death and to improve long-term prognostication could greatly facilitate improved survival for some groups of patients and improved end-of-life care for others.
Angus DC. Do Findings of High Mortality From Pneumonia in the Elderly Make It the Old Man's Friend?—Reply. Arch Intern Med. 2004;164(2):225. doi:10.1001/archinte.164.2.225-a