Although we have no quarrels with the analyses, we are concerned about the conclusions of Kaplan et al1 and Rozzini et al2 that pneumonia is still the old man's friend, confirming Osler's opinion expressed more than a century ago.3 Kaplan et al and Rozzini et al report high long-term mortality rates in elderly patients hospitalized with community-acquired pneumonia in the United States (41% at 1 year) and Italy (27% at 6 months), respectively. However, in these studies, mortality was only about one third higher compared with mortality from other causes. Moreover, even higher mortality rates are found in other populations. In frail Dutch nursing home residents with dementia, 90% of those who develop pneumonia and are not treated with antibiotics died within 30 days.4 Nonetheless, we do not think this justifies the conclusion that pneumonia is the old man's friend.
van der Steen JT, Ribbe MW, Mehr DR, van der Wal G. Do Findings of High Mortality From Pneumonia in the Elderly Make It the Old Man's Friend? Arch Intern Med. 2004;164(2):224–225. doi:10.1001/archinte.164.2.224
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