지역사회폐렴은 노인에서 더 흔하고 사망률도 높으며 심각한 경제적 비용을 초래한다. 노인 폐렴은 젊은 성인과는 자연경과나 임상경과가 달라 치료에 있어서 다르게 접근할 필요가 있다. 많은 경우 임상증상이 특이적이지 않아 진단이 쉽지 않고, 치료 또한 지연되기 쉽다. 따라서 기저질환을 포함한 임상증상의 악화를 보이는 경우에는 폐렴의 가능성을 항상 생각해야 한다. 외래와 입원치료의 결정은 CURB-65나 PSI를 참고로 여러가지 요인들을 고려하여야 한다. 경험적 항생제를 선택할 때는 먼저 지역사회폐렴인지 HCAP인지를 구분하고, 환자의 동반질환이나 건강상태를 종합적으로 고려하여 적절하고 항생제를 빠른 시간 내에 투여하여야 좋은 치료결과를 얻게 된다. 폐렴을 예방하기 위해서는 흡인의 기회를 줄이고, 금연 및 예방접종을 권한다.

Community-acquired pneumonia (CAP) is one of major medical illness and leading causes of death in the elderly patients. They account for the majority of CAP-related hospital admission, and suffer from more severe degree of illness that often requires broad-spectrum antibiotics and intensive care unit (ICU) admission. Recently, the incidence and mortality of CAP is rising. Therefore, the economic and clinical burden is expected to increase consistently at present time and also in the future. Although Streptococcus pneumoniae is still the most common pathogen identified, pneumonia in elderly patients is different from that in younger patients, with regard to the etiology, clinical course, and treatment response. The most striking characteristic of pneumonia in older patients is its clinical presentation: classic symptoms are often absent. Therefore, appropriate diagnosis and treatment can be delayed. When approaching the treatment for pneumonia in older patients, patients with healthcare-associated pneumonia (HCAP) should be distinguished from those with CAP. Patients with HCAP are at high risk for multidrug-resistant (MDR) pathogens and tend to have much more severe illness due to multiple co-morbidities and decreased functional status, which are associated with poor outcome. Prevention should also be implemented, focusing on smoking cessation, aspiration prevention, and influenza and pneumococcal vaccination. (Korean J Med 75:129-140, 2008)