Pneumonia is common in the elderly and clinical manifestations are frequently atypical. Pneumonia should be considered in any older person presenting with falls, confusion, incontinence, worsening comorbidities or a deterioration in functional status. The respiratory rate is the most reliable sign to alert the health carer to the presence of pneumonia. Therapy should follow the recommendations of the South African Pneumonia Guidelines. Prevention strategies include the prevention and management of aspiration, reduction in the use of neuroleptic medication, influenza vaccination, maintenance of oral hygiene, smoking cessation and possibly the use of the newer antiviral preparations.