Respiratory and Infectious Diseases
Pneumonia and Respiratory Infections
Community-acquired pneumonia in older adults may present without fever or cough - confusion, falls, or functional decline may be the only signs. Assess severity with a validated tool such as CURB-65 (confusion, urea, respiratory rate, blood pressure, age 65 or older) to guide site of care. Empiric therapy should cover typical bacteria; add coverage for atypical organisms or MRSA/Pseudomonas when risk factors exist. Short courses (5–7 days) are appropriate once clinically stable.
COPD and Asthma
COPD management includes bronchodilators (long-acting muscarinic antagonists and long-acting beta agonists), inhaled corticosteroids for exacerbation-prone patients, smoking cessation, and vaccination. Inhaler technique must be taught and reassessed; spacers help. Oral corticosteroids for exacerbations are short courses; watch for hyperglycemia and delirium. Oxygen targets in COPD with chronic hypercapnia are typically 88–92% to avoid worsening hypercapnia.
Vaccination and Stewardship
Know adult immunization: influenza annually, COVID-19 per current schedule, pneumococcal vaccination, recombinant zoster, Tdap, and RSV for older adults per guidance. Antimicrobial stewardship matters because older adults experience more adverse drug events and C. difficile.
Tuberculosis
Consider latent tuberculosis screening before starting biologics or in high-risk settings; treat latent infection to prevent reactivation.
Traps
Stems may omit fever and expect you to recognize atypical presentation; another trap is treating a colonized sputum culture in a stable patient, or continuing antibiotics beyond clinical resolution.
Rule of Thumb
In an older adult with acute functional decline or confusion, include pneumonia and urinary infection in the differential even without fever, and use severity scoring to decide inpatient versus outpatient care.