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July 14, 1997

Influence of Age on Symptoms at Presentation in Patients With Community-Acquired Pneumonia

Author Affiliations

From the General Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Drs Metlay, Singer, and Coley); Division of General Internal Medicine, Departments of Medicine (Ms Hough, Mr Obrosky, and Drs Kapoor and Fine), Psychiatry (Dr Schulz), and Biostatistics (Dr Li), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa; and Department of Medicine and Microbiology, Victoria General Hospital and Dalhousie, University, Halifax, Nova Scotia (Dr Marrie). Dr Li is now with Tzu-Chi College of Medicine, Hau-Lien, Taiwan.

Arch Intern Med. 1997;157(13):1453-1459. doi:10.1001/archinte.1997.00440340089009

Background:  Advanced age has become a well-recognized risk factor for death in patients with pneumonia. It may also be associated with reduced symptom reporting, raising the possibility that diagnosis and treatment may be delayed in older patients.

Objective:  To evaluate the association between age and the presenting symptoms in patients with community-acquired pneumonia.

Methods:  This study was conducted at inpatient and out-patient facilities at 3 university hospitals, 1 community hospital, and 1 staff-model health maintenance organization. Patients included adults (age ≥18 years) with clinical and radiographic evidence of pneumonia, who were able to complete a baseline interview. The presence of 5 respiratory symptoms and 13 nonrespiratory symptoms were recorded during a baseline patient interview. A summary symptom score was computed as the total number of symptoms at presentation.

Results:  The 1812 eligible study patients were categorized into 4 age groups: 18 through 44 years (43%), 45 through 64 years (25%), 65 through 74 years (17%), and 75 years or older (15%). For 17 of the 18 symptoms, there were significant decreases in reported prevalence with increasing age (P<.01). In a linear regression analysis, controlling for patient demographics, comorbidity, and severity of illness at presentation, older age remained associated with lower symptom scores (P<.001).

Conclusions:  Respiratory and nonrespiratory symptoms are less commonly reported by older patients with pneumonia, even after controlling for the increased comorbidity and illness severity in these older patients. Recognition of this phenomenon by clinicians and patients is essential given the increased mortality in elderly patients with pneumonia.Arch Intern Med. 1997;157:1453-1459