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Although we have no quarrels with the analyses, we are concerned about the conclusions of Kaplan et al¹ and Rozzini et al² that pneumonia is still the old man's friend, confirming Osler's opinion expressed more than a century ago.³ Kaplan et al and Rozzini et al report high long-term mortality rates in elderly patients hospitalized with community-acquired pneumonia in the United States (41% at 1 year) and Italy (27% at 6 months), respectively. However, in these studies, mortality was only about one third higher compared with mortality from other causes. Moreover, even higher mortality rates are found in other populations. In frail Dutch nursing home residents with dementia, 90% of those who develop pneumonia and are not treated with antibiotics died within 30 days.⁴ Nonetheless, we do not think this justifies the conclusion that pneumonia is the old man's friend.

Osler's famous words address at least 2 more aspects of . . . [Full Text of this Article]

Jenny T. van der Steen, PhD; Miel W. Ribbe, MD, PhD; David R. Mehr, MD, MS; Gerrit van der Wal, MD, PhD
Amsterdam, the Netherlands

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