TY - JOUR T1 - Natural enemy or friend? Pneumonia in the very elderly critically ill patient JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0031-2020 VL - 29 IS - 155 SP - 200031 AU - Michael S. Niederman Y1 - 2020/03/31 UR - http://err.ersjournals.com/content/29/155/200031.abstract N2 - Pneumonia has been a serious cause of morbidity and mortality for many years and, more than 100 years ago, Sir William Osler referred to it as “the natural enemy of the old man” [1]. Many studies have documented that elderly individuals have a higher frequency of illness, increased mortality and more subtle clinical features compared to younger populations. This too was known by Osler who commented that “it is not improbable that debility lowers the vitality and renders the individual susceptible” and when the illness occurs, it can be “without chill; the cough and expectoration are slight” and the physical findings non-specific [1]. He noted that while fever was not usually prominent, patients often had altered mental status and that pneumonia could precipitate congestive heart failure [1].Pneumonia is a common problem in the elderly with higher short- and long-term mortality than younger patients and similar age patients with other illnesses. Aggressive care may not be justified and broad-spectrum antibiotics may create antibiotic resistant pathogens that harm others. http://bit.ly/2P8LUNp ER -