Drs Rozzini and Trabucchi found a high mortality in elderly patients with the diagnosis of pneumonia similar to our recent study.1 Compared with our study, their data are from an elderly population (mean age 81.5 ± 7.6 and 79.7 ± 7.1 years) admitted to a geriatric center during the 36-month analysis. They reported a significantly higher 3-month mortality of patients with community-acquired pneumonia (CAP) (19.2%) vs patients without pneumonia (10.3%). The data presented by Drs Rozzini and Trabucchi add to the current evidence that pneumonia plays a role in the mortality of patients beyond the conventionally used 28-day final follow-up. In elderly patients with severe underlying conditions, an episode of CAP may be a marker of severe immunologic impairment. These patients are likely to die “with CAP.” On the other hand, in other elderly patients, CAP may reflect a transient breach in the normal respiratory immune mechanisms. In this scenario, the systemic inflammatory response due to CAP may accelerate the natural history of underlying conditions favoring poor outcomes. These patients are likely to die “due to CAP.” More research is needed to investigate the relation between CAP and long-term outcomes in elderly and very elderly patients hospitalized with CAP.