The onset of bacterial pneumonia in an older individual may be insidious with nonspecific signs, such as confusion, falls, lethargy, and anorexia. On occasion, pneumonia may exacerbate coexistent diseases, making the initial diagnosis very difficult. Chest x-rays are often unremarkable, without the typical lobar consolidation and air bronchograms. Laboratory testing can also be confusing because older patients with pneumonia often present with a normal or only slightly increased leukocyte count. Prevention of community-acquired pneumonia in older adults is just as important as timely diagnosis and treatment.
Smoking cessation improves the respiratory mucociliary function.
Good oral hygiene and vaccination against Streptococcus pneumoniae and viral influenzae should be strongly encouraged. An ECG obtained within 2 hours of symptom onset was consistent with an acute inferior wall myocardial infarction. However, thrombolytic therapy was contraindicated because of a markedly depressed hematocrit that suggested possible gastrointestinal bleeding. Urgent two-vessel percutaneous transluminal coronary angioplasty performed on the day of admission was uneventful. After the patient was stabilized, an esophagoduodenoscopy to evaluate the patient's anemia revealed three duodenal ulcers.