I. Clinical Question: Is there a clinical difference in the elderly with pneumonia compared to younger population? II.

Citation: Comparing community acquired pneumonia between elderly population and others (Mahshid Talebi-Taher*, eied-!li "a#ad-Mousa#i, ara !rian-Mehr, Mitra $arati% III.Study Characteristics 1. Patients included: !ll patients o#er &' years of age admitted to our hospitals with community acquired pneumonia, was carried out o#er a period of &( months) !ll adult patients and o#er *+ years old (elderly patients% diagnosed with pneumonia) !ll patients with unresol#ed pneumonia and hospital acquired pneumonia were e,cluded) !ll personal information, clinical manifestations (symptoms and signs%, underlying and chronic disease, laboratory findings (leu-ocytosis%, outcome and other necessary data were recorded in special data sheets) 2. Interventions compared: !ll patients aged &'-*+ years (non-elderly patients% and o#er *+ years (elderly patients% diagnosed with C!. were e,amined and followed by two of the authors distinctly) 3. Outcomes compared: The comparati#e study between the two populations (older and younger than */ years%, found few clinical differences0 dyspnea was more frequent in elderly #ersus fe#erish chills more in younger0 considering auscultation, crac-les were more frequent in older sub1ects (&2%0 but in our setting there was no significant differences between two groups when considering crac-le) 4. Does the study ocus on a si!ni icant pro"lem in clinical practice# This study focuses on significant problem on clinical practice) .neumonia is a ma1or public health problem in the elderly in general& and in nursing home residents in particular) The elderly ha#e higher rates of pneumonia associated morbidity and mortality0 in fact, pneumonia is one of the top fi#e leading causes of death among older adults in the 3nited tates) 4eco#ery from pneumonia ta-es longer in the elderly, and associated complications and mortality are more frequent than in younger adults)

I$. %ethodolo!y&Desi!n 1. %ethodolo!y used The methodology used in this research is a prospecti#e study 2. Desi!n Clinical tudy 5esign 3. Settin! This study was conducted on a 6ducational Center) 4. Data Sources !ntimicrobial 4esistance 4esearch Centre, Tehran 3ni#ersity of Medical ciences, Tehran, Iran) '. Su"(ect Selection !ll patients o#er &' years of age admitted to two teaching hospitals with C!., was carried out from May (//7 to May (//8) !ll patients aged &'-*+ years (non-elderly patients% and o#er *+ years (elderly patients% diagnosed with C!.) !ll patients with unresol#ed pneumonia and hospital acquired pneumonia were e,cluded) !ll personal information, clinical manifestations (symptoms and signs%, underlying and chronic disease, laboratory findings (leu-ocytosis%, outcome and other necessary data were recorded in special data sheets) ). *as the ori!inal study "een replicated# This study was already done before) Thus, this only means that e#en from the past until now, and in the future there are still studies for this -ind of problem) Thru this new study, it gi#es more information and also it inquires more related health -nowledge) +. ,hat are the ris-s and "ene its o the nursin! action&intervention tested in the study# The benefit of this study is establishing diagnostic and management protocol for

pneumonia for elderly and non- elderly populations, meanwhile, 9eriatric Medicine should be considered more seriously in the educational and therapeutic health care centers) 4is-s were obser#ed in the educational centers that increase mortality rate for those elderly who li#ed in nursing homes, healthcare centers, or were being cared by their children)

$. .esults o the Study

Totally, &82 patients (&/2 elderly% were studied) The mean age of the participants (: 5% was +;:(' years) The main manifestations of pneumonia in elderly patients were as follow< tachypnea (*'=%, cough (*(=%, and fe#er (2'=% respecti#ely) >ur results showed that the frequency of fe#er (p?/)/'%, chest pain (p?/)//&%, and pleuritic pain (p?/)//&% decrease with aging, howe#er, mental status changes (p?/)/&+%, and C@A (p?/)/(% increase with aging) Thirty onempatients (&7=% died, of whom (; were o#er *+ years of age (p?/)//&%) 3nfortunately, 2& patients (&7=% died, of whom (; belonged to elderly group as compared with ( cases in the other group) Indeed, a significant correlation was found between the mortality rate, age and C34$-*+ score0 as ;'= of the patients who died of pneumonia, were o#er *+ years of age (>4?')&, ;+=CI?/)*-*)8, p?/)//&% while all were grouped in C34$*+ class B2) Moreo#er, mortality rate was not correlated with gender, e#en though it had significant correlation with patientsC condition of life) De#ertheless, ;2= of patients who died of pneumonia li#ed in nursing homes, health care centers or were being cared by their children or relati#es due to their inability to li#e independently (p?/)//&%)

$I. /uthors Conclusion&.ecommendations 1. ,hat contri"ution to client health status does the nursin! action&intervention ma-e# In conclusion, the study recommend establishing diagnostic and management protocol for pneumonia for elderly and non- elderly populations, meanwhile, 9eriatric Medicine should be considered more seriously in the educational and therapeutic health care centers) 2. ,hat overall contri"ution to nursin! -no0led!e does the study ma-e# The study has se#eral strengths) It used comparati#e study to compare the elderly and younger population with pneumonia) Its contribution to nursing -nowledge are<

a) To -now the manifestations that are se#ere in the elderly compared to the younger ones) b) To formulate inter#entions needed specifically by the elderly)

$II.

/pplica"ility

1. Does the study provide a direct enou!h ans0er to your clinical 1uestion in terms o type o patients2 intervention and outcomes# Ees) It gi#es direct answer to my clinical question because it sited methods to ha#e a good result and also it pro#ides enough data to answer the unanswered question)

2. Is it easi"le to carry out the nursin! action in the real 0orld# I thin- it is safe to carry out the nursing action in the real world because conducting the study can produce desired outcomes and inter#entions to impro#e the actions needed by the clients with pneumonia specially the elder ones) $III. .evie0er3s Conclusion&Commentary I conclude that there are only a few clinical difference to the elderly compared to the younger population) $ut despite these few differences, it is still #ital both the age groups to recei#e care appropriate to their manifestations, though with special considerations to the elderly specifically the dyspnea, which is less frequent to the younger populations) I4. 5valuatin! 6ursin! Care Practices

1. Sa ety The safety obser#ed in this study was measured by the e#aluation upon admissions of the sub1ects) The authors also researched about the mortality rate of the patients who were admitted to the centers) Considering the present criteria, mortality rates in patients with se#ere pneumonia who need intensi#e care, are reported (/ to +2= ((&%) Mortality rates of C!. were higher in this study, compared with the pre#ious studies, which might be due to inappropriate management, delay in patientsC referral to the physicians, the older age group, li#ing in nursing home, or greater pre#alence of underlying disease) 2. Competence o the care provider The role of the @ealth Care .ro#ider is to ma-e sure heFshe is -nowledgeable and s-ill full in handling patients with pneumonia) Competency is measured by how appropriate, how

effecti#e and how efficient the primary health care to be deli#ered or rendered) Gith these we can conclude that a health care pro#ider is competent enough so long as heFshe is equipped with the right -nowledge and s-ill 3. /ccepta"ility It was found out in the study that there were a few differences in the clinical manifestations of the elderly and non elderly, but despite the result it is still acceptable because it is important to be familiar with these differences to a#oid unnecessary delays in prompt diagnosis) 4. 5 ectiveness 6#aluation of the manifestation and outcome of pneumonia in the elderly and non elderly is effecti#e specially when it comes in formulating inter#ention necessary in both age groups) '. /ppropriateness The comparison conducted in this study is appropriate in terms of their e#aluation) ). 5 iciency The study is efficient specially to the elderly to a#oid delay in inter#ention and diagnosis and to decrease mortality) +. /ccessi"ility ince the study focuses on the e#aluation of the manifestation, it is helpful to the readers to -now the clinical differences of the elder and younger so that inter#ention would be appropriate in terms of their needs, therefore inter#entions regarding pneumonia is accessible and accepted in the .hilippines)