health, by noahgold


									The Killer Number Four in the Elderly

MAIN concoction - Issue April 2007 (Vol.6 No.9)

Malnutrition is considered a risk factor for pneumonia in the elderly in today's era of antibiotics,
pneumonia mortality in the elderly remains high. Another preventive efforts is to improve the nutritional
status of the elderly.

The mother lay on the bed. It is 1 month old, he was hospitalized. Her elderly it is no longer powered.
From his nostrils plugged hose meal. Occasionally he coughs up phlegm, but difficult once issued. He
also consulted the complaint to the doctor.

Then, a specialist in pulmonary merontgen chest 70-year-old geeks. Doctors say that there is an infection
in his lungs. His son had no idea. In fact admission, the mother is not a fever. Only weak, not eating and
occasional cough. 've Spent dozens of vials of antibiotics, yet also the mother did not show

At the age old, the physiological function of the body's aging, too. The immune system is no longer as
active as before. Predictably, those who are classified as elderly (over 65 years) easily attacked by
diseases, such as respiratory problems.

The more old, more Rocketed

Respiratory infections has become a scourge for the elderly. In developed countries, like the United
States, pneumonia and influenza was ranked as the fourth highest cause of death. Found about 18.2
cases of pneumonia per 1000 population aged 65-69 years. That number skyrocketed to 52.3 cases per
1000 population aged 85 years and over. In Taiwan, deaths from pneumonia reached nearly 200 per
100,000 elderly patients in 2002. It can also be concluded, the risk of pneumonia at the age of> 65 6
times higher than the age <60 years.

          Increased incidence and prevalence of pneumonia in the elderly is also associated with
comorbid illnesses suffered by patients, such as diabetes mellitus, heart disease, malnutrition, and
chronic liver disease. For example, diabetes mellitus causes a reduction in the body's immune system
both chemotaxis and phagocytosis. In congestive heart failure with pulmonary edema, decreased
pulmonary function clearance so that the colonization of the respiratory germs multiply easily. Patients
who previously often drugs that are sedatives or hypnotics high risk of aspiration of making it easier for
the infection. That is because both drugs suppress excitatory mukosilier cough and clearance work.

Streptococcus pneumoniae
The etiology of pneumonia can not be predictable based solely on clinical symptoms, laboratory results,
and radiological. Classics such as bulging fissure sign in Klebsiella pneumoniae, Legionella hyponatremia
due, or atypical symptoms due to Mycoplasma, are not sufficiently sensitive and specific. Patterns of
microorganisms that cause pneumonia in the elderly is somewhat different to that found at a young age.
Nevertheless, Streptococcus pneumoniae remains the most common etiology. Several other
microorganisms are Gram-negative, respiratory viruses such as respiratory syncytial virus and influenza
A, and atypical bacteria. According to Finnish studies, Streptococcus pneumoniae into the etiology of
most (48%) in patients over 60 years, followed by Chlamydia pneumoniae (12%), Mycoplasma
pneumoniae (10%), Haemophilus influenzae (4%), and viruses (10%).

Regarding etiology, data collected by the Department of Microbiology, Faculty of Medicine in 2005
different from the results abroad. According to Dr. Pratiwi Soedharmono PhD, in Indonesia, is the most
common etiology K. S. pneumoniae is not pneumoniae. It may be that the specimens were examined not
from the first patient suffering from pneumonia Community, so the chances of this bacteria is a bacteria
obtained from a hospital, or a recurrent infection.

Clinical symptoms Unclear

Pneumonia in the elderly becomes an important issue to be discussed. In addition to the growing
prevalence skyrocketed, the classic symptoms of pneumonia are not found in elderly patients.

This is in accordance with prejudice Osler, author of The Principles and Practice of Medicine, 1982, which
reads "In old age pneumonia may be latent, coming on without chill. Cough and expectoration is the
slight, signs of physical ill-defined and changeable, and the constitutional symptoms out of all
proportion. Of fever there may be none. Fever is higher in healthy adults than in old persons and
drunkards. "Thus, it appears the deceleration linear relationship between age with clinical symptoms.
means increasing the age of a patient the clinical symptoms are not obvious.

No details of the classic symptoms that are blamed to be one cause of the high mortality rate of
pneumonia in the elderly. The three most common symptoms in the elderly are shortness of breath
(dyspnea), cough, and fever. What was raised by Dr. Priyanti Soepandi SPP (K) in Pulmonology and
Medical Scientific Meeting (PIPKRA) 4th February 2006, slightly different from the literature. Several
studies revealed approximately 35-65% of elderly patients found no presence of fever. Another symptom
is rarely pleuritic chest pain, headache, myalgia, nausea / vomiting, diarrhea, fall, and sore throat. While
coughing, shortness of breath, sputum production, and weak body is the most common symptom. Can
also encountered patients chills, sweating, tachycardia, and delirium.

While physical examination, further Priyanti, crackles and rhonchi earned. On chest X-ray picture, it looks
abnormal alveolar (81%) and unilateral abnormalities of the lung (70%). Often elderly patients suffering
from pneumonia suspicion emerged after investigation, the discovery of leukocytosis and changes
overview progressive lung x-rays.
Pneumonia Patient Community

Patient age> 50 years?

Does the patient have a history of disease as follows:

· Malignancy / neoplasm

· Liver disease

· Congestive heart failure

· Cerebrovascular Disease

· Kidney Disease

Do patients have abnormalities obtained from physical examination:

· Changes in mental status

· Frequency of breathing ≥ 30x/menit

· Systolic BP ≤ 90 mmHg

· Frequency pulse ≥ 125x/menit

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