Pneumonia in the Elderly

Pneumonia involves an infection or inflammation of the alveoli of the lungs and the lung tissue. Pneumonia can be caused by viruses, fungi, or bacteria, although there are types of pneumonia that are not infection-related but are due to the inhalation of toxic material or foreign substances into the lung tissue. About 50,000 individuals in the US will die each year as a result of pneumonia. Pneumonia in the elderly is a common cause of death in older people, because they have a weaker immune system compared to young people.

Why Are the Elderly People More Susceptible to Pneumonia?

Pneumonia in the elderly is nothing to take lightly. Not only are the elderly at a greater risk of developing pneumonia, but also they have a greater risk of dying from the disease. Here are some reasons why the elderly are at a higher risk of getting pneumonia.

  • Elderly people are frailer. People who are older are basically frailer than younger people. They are unable to cough well enough to clear mucus from the lungs, which then causes the mucus to travel down the bronchial tree and into the lungs where infection sets in.
  • Elderly people have weakened immune systems. The weaker immune systems of the elderly mean that they are unable to fight off infections like pneumonia effectively. Elderly people are more likely to be immunosuppressed from having had an organ transplant, taking steroids for long periods of time, or taking chemotherapy for cancer. In addition, the elderly person is less able to recognize the symptoms of pneumonia, because their immune systems don't respond the same as that in younger people.
  • There are other health conditions in seniors. Seniors are more likely to have other health problems, including Parkinson's disease, HIV, chemotherapy, or diabetes,which make them more likely to have pneumonia. Pneumonia in the elderly is also associated with lung diseases such as asthma, chronic obstructive lung disease, cystic fibrosis, or bronchiectasis.
  • Surgery affects the risk of pneumonia. Elderly individuals who have to have surgery are more likely to get pneumonia later on. When the elderly person is given medications for pain, they are more likely to take shallower breaths, which causes the secretions to collect in the lungs.
  • The elderly have nourishment issues. Many elderly persons tend not to get various nutritions necessary to fight off infections. They can't fight off illness as well when they are so malnourished. If they live in a nursing facility, there is more likely to be bacteria around that can result in pneumonia.

What Are the Symptoms of Pneumonia in the Elderly?

There are more than 30 different kinds of microorganisms that can result in pneumonia in the elderly. Depending on the strain of microorganism, the symptoms of pneumonia can be different. There are some typical symptoms of pneumonia, however, that you should be aware of:

  • Coughing
  • The production of yellow or green sputum
  • Feeling weak or experiencing malaise
  • Having chest pain
  • Having fever and chills
  • Being confused
  • Being short of breath

Sometimes, the elderly person may believe they are just suffering from the flu or have a cold. In addition, doctors believe that the signs and symptoms of pneumonia in elderly persons are different from those seen in young people.

Pneumonia in the elderly can be silent, without the typical symptoms. They may have a slight cough and bring up small amounts of sputum, exhibiting signs that are changeable and ill-defined. The constitutional symptoms of pneumonia may not be suggestive of the disease. Older people may not have a fever, even when they have a serious case of pneumonia.

Rather than the typical symptoms, the elderly person might be more lethargic or sleepy; they may have a loss of appetite or may be dizzy, resulting in falls. If the elderly person has some type of dementia, they may be unable to tell you exactly what they are feeling even though they have a serious case of pneumonia.

How to Diagnose Pneumonia in the Elderly

There are tests that can be done to tell if an elderly person has pneumonia. The doctor can simply listen to the individual's lungs for rattling sounds and rales (bubbling sounds) that are typical of pneumonia and lung inflammation. A chest x-ray or CT scan will show areas of pneumonia, called consolidation. A pulse oximetry test checks for the level of oxygen in the system, which tends to be lower if the person has pneumonia. In some cases, the mucus or blood can be cultured to identify the specific organism that is causing the pneumonia.

How to Treat Pneumonia in the Elderly

The best treatment for pneumonia is to use antibiotics to kill the bacterial or fungal organisms. The anti-microbial medication of choice depends on which organism is causing the infection, the chance that the organism is resistant to the basic antibiotics, and the underlying condition of the patient's health.

About 80 percent of community-acquired pneumonia can safely be treated at home with just the use of oral antibiotics. Empiric treatment is given when the exact organism and its sensitivities are not known. When the exact cause of the pneumonia is identified, the exact antibiotic against the microorganism can be used and the treatment can become more tailored. About 20 percent, pneumonia must be treated in a hospital with IV antibiotics.

If the pneumonia is due to a virus, no antibiotic is available to treat this type of infection. Sometimes, antiviral medication can be used to treat the pneumonia. These types of medications are best given early in the course of the disease and include medications like Tamiflu and Relenza. Fungal pneumonias are treated with anti-fungal medications.

How to Prevent Pneumonia in the Elderly

Fortunately, pneumonia in the elderly can be prevented. Here are some ways to prevent it:

  • Influenza vaccine. While the influenza vaccine doesn't work as well in the elderly as in young people, it can afford some protection against viral pneumonia. If they do get a case of the flu, it is often milder and causes pneumonia to a lesser degree. The influenza vaccine is given yearly.
  • Pneumococcal vaccine. This is a type of vaccine that protects against many different strains of bacteria that result in pneumonia. It is important to remember that the pneumococcal vaccine doesn't last as long as it does in younger people. You should get your first shot around age 50 and a second shot at the age of 65. New vaccinations should be given every five years or so.
  • Hand washing. Hand washing is important in the prevention of the spread of diseases like pneumonia.
  • Good health habits. The elderly should try to get enough exercise and enough sleep, as well as eating healthy foods to improve their resistance to getting pneumonia. They should also stay away from people who are suffering from a cold or flu.
  • Dental hygiene. Pneumonia can occur from the bacteria that gather around teeth that are infected. Teeth should be brushed and dental work should be taken care of by the dentist. 
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