Pneumonia and the Elderly
Last Updated: April 4, 2013
In 2010, pneumonia, combined with influenza, was the 8th leading
cause of death in the United Sates, according to the National
Center for Health Statistics. This fact is illuminated by another
statistic: 1 out of 20 adults who get pneumonia dies, says the
Centers for Disease Control. Preventing pneumonia in the elderly a
"Pneumonia is an inflammation of the lungs usually caused by
bacteria, viruses, fungi or other organisms," says Dr. Norman
Edelman, the chief medical officer for the American Lung
Association. This inflammation causes an outpouring of fluid in the
infected part of the lungs, affecting either one or both lungs. The
blood flow to the infected portion of the lung (or lungs)
decreases, meaning oxygen levels in the bloodstream can
"This decline is more likely to happen in an elderly, sick,
and/or debilitated 85-year-old. The body attempts to preserve blood
flow to vital organs and decrease blood flow to other parts of the
body such as the GI tract," says Dr. Joseph Mylotte, a professor of
medicine at the School of Medicine and Biomedical Sciences at the
University of Buffalo. "The effects [of pneumonia] are widespread
even though the infection is localized to the lung." The
complications of pneumonia in the elderly can be life-threatening,
from low blood pressure and kidney failure to bacteremia, an
infection that spreads to the bloodstream.
Elderly people are more susceptible to pneumonia for several
reasons. Often they already suffer from co-morbid conditions such
as heart disease, which means they don't tolerate infection as well
as younger people, says Mylotte. Age also causes a decrease in an
older person's immune system response, so his defenses are weaker.
"Some virulent organisms can cause infection in younger people, but
the infections can be worse in older people," says Mylotte.
Pneumonia is caused by more than thirty types of organisms;
these different strains mean that symptoms can vary from case to
case. However, the following symptoms can signal a bout of
- Malaise or feeling weak
- Green or yellow sputum
- Pain in the chest
- Shortness of Breath
Often, a person may think she is simply suffering from the cold
or flu. Also, it is widely believed that the signs of pneumonia in
the elderly can differ from the general population. An older
patient might not have a fever. "The symptoms and signs are
sometimes not as specific. They may be more sleepy and lethargic,
or lose their appetites, or they may suffer from dizziness and
fall. If there is underlying
dementia, they might not be able to tell you how they feel. But
it's all related to something going on in the lung," says
People are often exposed to the organisms that cause this
disease, but the lungs' defense mechanisms usually protect people
from infection. Sometimes these organisms break through a person's
immune system, infecting the lungs' air sacs. Each lung has a major
airway (bronchus) that divides into twenty-two tubes; these tubes
further divide into more than one hundred thousand tiny tubes
(bronchioles) that end in clusters of tiny air sacs (alveoli),
where the transfer of oxygen to the body's bloodstream takes place.
When a patient has pneumonia, the affected air sacs become inflamed
and filled with fluid. This leads to breathing problems, a lack of
blood flow to the infected sections of the lungs, and a decrease in
the bloodstream's oxygen level.
Diagnosis and Causes
Simple diagnostic tests can confirm a case of pneumonia in the
elderly. A doctor who listens to a patient's lungs may hear
bubbling sounds called rales and rattling sounds called rhonchus,
which signal infection and inflammation in the lungs. A pulse
oximetry test computes the blood's oxygen levels. A chest x-ray or
CT scan is often the definitive diagnosis, telling the physician
where the infection is and the degree of the illness. Sometimes a
doctor will have the patient's phlegm or blood analyzed to decipher
which organism is responsible for the infection.
Although pneumonia can be caused by more than two dozen
organisms, pneumonia in the elderly is usually caused by bacteria
or viruses. The streptococcus (or pneumococcal) pneumonia bacteria
is responsible for an estimated forty thousand deaths every year,
according to the Centers for Disease Control. The elderly are more
likely to catch this strain of pneumonia. Streptococcus pneumonia
can come on slowly or suddenly. It can damage the lungs, cause
bacteremia in the bloodstream, and meningitis in the brain.
Viruses also trigger this disease, and are thought to cause
about 50 percent of pneumonia infections in the general population.
Usually viral pneumonia is less severe, but complications can
include bacterial pneumonia.
Atypical pneumonia-causing organisms-such as mycoplasma and
chlamydia-rarely cause pneumonia in the elderly. In the nursing home
population, a small percentage of people suffer from severe
pneumonia strains caused by organisms such as Gram-negative
bacteria and Staphylococcus aureus, which can quickly end in death
or with the patient on a respirator, says Mylotte.
Treatment and Practical Management
Patients are treated for pneumonia depending upon which organism
triggered the disease. Your loved one's medical provider can
ascertain this through analyzing a phlegm or blood sample.
For a case ofviralpneumonia, some patients may receive antiviral
medications, but these are not commonly prescribed. And antibiotics
are not used because they aren't effective against viruses. Bouts
of viral pneumonia usually heal without medication, provided the
patient rests, eats healthy food, and takes in plenty of fluids. If
new symptoms arise, it is important to contact your loved one's
doctor, as bacterial pneumonia is a possible complication.
Bacterialpneumonia is always treated with antibiotics. If a
patient is in the hospital, it is typical for the hospital to
follow strict treatment guidelines. These guidelines are part of
pay-for-performance programs, meaning the doctor will get paid a
better rate if she follows the guidelines, says Mylotte. Both the
American Thoracic Society (www.thoracic.org) and the
Infectious Diseases Society of America (www.idsociety.org) have
standard treatment guidelines available on their respective
websites. These are based on where the patient acquired the
disease-in the community, in the nursing home, in the hospital-and
these guidelines can be found on each organization's website.
Whether the patient is at home or in the hospital, he is usually
administered a once-a-day therapy. Effective antibiotic treatments
include respiratory fluoroquinolones such as moxifloxacin, says
Mylotte, although there are several antibiotic therapies that work
as well as these.
Treating bacterial pneumonia has become more complicated due to
antibiotic resistance: The organisms that cause this disease mutate
and can become resistant to drug treatment. This is one reason that
it is important for a patient to finish her entire course of
antibiotics; stopping treatment early actually encourages
antibiotic resistance. Up until two years ago, antibiotic
resistance associated with bacterial pneumonia had been increasing,
but it has recently decreased, according to Mylotte.
Both mycoplasma and chlamydia pneumonias are also treated with
antibiotics. Mycoplasma pneumonia is also known as walking
pneumonia. If your loved one has this strain, he or she usually
will have milder symptoms, but it can take four to six weeks to
Most pneumonia patients heal at home. About 15 to 20 percent of
people with community-acquired pneumonia are treated in the
hospital, while about 20 to 30 percent of people with nursing-home
acquired pneumonia are also admitted to a hospital, according to
Whether a patient stays at home or in a hospital, she may take
medications to ease fever, aches, and coughing bouts. Because
coughing actually helps rid lung infection, this action shouldn't
be entirely reduced. However, if the patient isn't getting any
sleep, a low-dose cough suppressant can be prescribed. Patients
with severe strains may need oxygen therapy to increase
blood-oxygen levels. Caregivers should make sure a loved one is
receiving proper hydration, eating at least a small amount of
healthy food, and reporting worsening or new complications, says
the American Lung Association's Edelman.
Complications that can arise from pneumonia include:
- Bacteremia: The possibly deadly infection invades the
bloodstream and can infect the body's organs.
- Pleurisy and empyema: With pleurisy, the membrane that covers
the lungs (pleura) becomes inflamed. Empyema occurs when fluids
causing inflammation become infected.
- Lung abscess: A pus-filled cavity can develop in the infected
- Acute Respiratory Distress Syndrome (ARDS): When the lungs
become severely injured due to pneumonia, respiratory failure can
occur. Treatment includes the use of a mechanical ventilator (vent)
and supplemental oxygen.
Pneumonia in the elderly as well as younger people occurs when a
person's immune system is weakened. Although it can be transmitted
via the air or hand-to-hand contact, if a person's immune system is
strong he can fight off this infection. Preventing this disease
with the following steps can keep it at bay:
- Pneumococcal vaccine: This vaccine helps prevent twenty-three
different strains of bacterial pneumonia (although there are many
more strains of bacterial pneumonia out there). "It doesn't always
engender a good immune response in adults, so it doesn't always
work well," says Mylotte. He also points out the vaccine is
effective for a shorter amount of time in older people. Experts
recommend getting your first dose when you are in your 50s and your
second dose at age 65, and then a new dose should be administered
every five years.
- Influenza vaccine: This vaccine is just as important as the
pneumococcal vaccine. It doesn't work as well in elderly people,
says Mylotte, but if an older vaccinated person gets the flu, it is
usually a milder case. Pneumonia is often a secondary infection
after an initial bout of influenza; people who receive this vaccine
have less risk of developing pneumonia as a flu complication. Older
adults should get a
flu shot every year.
- Wash hands: "I always tell people to wash their hands as much
as they can. If your hands aren't raw in the wintertime, you are
not doing a good job," says Mylotte.
Dental hygiene: Pneumonia infections can occur around infected
teeth, says Edelman, so dental work should be kept in good
- Good health habits: Exercise, rest, and healthy eating can all
increase resistance to pneumonia.
Edelman also recommends that frail elderly people who are
already susceptible to infection should stay away from anyone who
has the flu or a bad cold. Of course, preventing pneumonia in the
elderly is always preferable to treating it. But if you suspect
your loved one is suffering from pneumonia, quick intervention can
be a life-saving occurrence.
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