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Pneumonia in elderly people - Causes, symptoms & treatment

Home > Pneumonia in children and infants - Signs, symptoms & causes > Causes, symptoms and treatment of pneumonia in elderly people
Pneumonia in elderly people, unlike younger patients, may have very subtle symptoms and by the time diagnosis is done and treatment is commenced the situation may become very serious and life threatening. Pneumonia is an inflammation of the lungs followed by fluid accumulation in alveoli air sacs and is usually caused by viruses, bacteria, fungi, parasites and other organisms. The inflammation and fluid accumulation in alveoli causes reduced blood flow to the affected part as well as reduced oxygen uptake.

In general elderly patients have feeble organ level and body level responses to any infection. Unfortunately, most of the elderly people and their caregivers are unable to understand the symptoms of pneumonia and by the time action is taken the condition turns serious.

Causes of pneumonia in elderly people

Though pneumonia is caused by viruses, bacteria, fungi and other organisms, in elderly, Streptococcus pneumoniae bacteria account for most of the infections and are the major cause of death. The infection can start with flue like symptoms of the upper respiratory tract and can spread fast to the lower respiratory tract and the lungs. Damage of lung tissue can occur and the infection may spread to the blood causing bacteremia. If most areas of the lungs are involved acute respiratory distress syndrome (ARDS) may be caused.

The complications of pneumonia in the elderly can be life-threatening, apart from the possibility of bacteremia, meningitis, kidney failure and heart failure can occur. The lung infections triggered by viruses are generally milder but there is always the risk of opportunistic bacterial infections including Streptococcus pneumoniae.

In elderly people, aspiration pneumonia is caused by difficulties in swallowing leading to mouth secretions and food going to the lungs and causing infection and pneumonia. Issues with swallowing are common in elderly patients which require treatment.

Symptoms of pneumonia in elderly people

General symptoms of pneumonia are:
  • week feeling
  • lethargy
  • productive cough
  • greenish or yellowish sputum
  • chills
  • difficulty in breathing
  • symptoms of shallow breathing
  • chest pain
  • muscle pain
  • fever
  • symptoms of skin and nails turning bluish
  • confusion
  • nausea
  • abdominal pain and diarrhea
  • decreased level of consciousness.
In elderly persons the pneumonia symptoms may be fewer and fever may not be present. Symptoms like Chest pain, shallow breathing, decreased appetite, feeling cold and difficulty in breathing may be observed. All the symptoms may not be present and observed symptoms can be pieced together to get a clearer picture of the situation. Symptoms like slightly confused state of mind together with changes in their behavior and appearance can also indicate the underlying problem.

Pneumonia - Tests and diagnosis
Simple diagnosis by listening to the patient's lungs can confirm pneumonia. Typical rales (clicking, rattling, or crackling noises) and rhonchus ( coarse rattling sound) can be picked up by a stethoscope signalling lung infection and inflammation. A chest x-ray or CT scan can confirm the disease and give us the location of inflammation. Blood and sputum analysis can tell us about the pathogen involved in pneumonia so that it can be treated.

Treatment of pneumonia in elderly people

Medical care must be sought for treatment if in the elderly person symptoms like have breathing problem or lung infection is suspected.
The cause of the pneumonia has to be found out for the treatment. Bacterial pneumonia is treated with antibiotics. Antibiotic treatment should carried out as per the advice of the doctor.

In rare cases antiviral medication is given for viral pneumonia. For the treatment of aspiration pneumonia corticosteroids may be prescribed. To reduce the fever antipyretic medicine may be prescribed. Unless necessary cough suppressants are avoided in the treatment.

Sufficient rest can help in alleviating the symptoms and also help in the treatment of pneumonia. Drinking plenty of fluids helps in loosening the lung secretions and their removal by coughing. With proper treatment the patient will recover in about two weeks.

Pneumonia - Risk factors in elderly people

Many habits and health conditions increase the risk of lung infections and pneumonia. Some of the risk factors are:
  • chronic obstructive pulmonary disease (COPD), cystic fibrosis, asthma, bronchiectasis
  • heart, lung, spleen or kidney diseases
  • health conditions like stroke, diabetes, dementia and Alzheimer's, amyotrophic lateral sclerosis (ALS)
  • untreated illness
  • decreased ability to cough
  • decreased productive cough
  • bad oral hygiene
  • inactivity
  • spending too much time in bed
  • malnutrition
  • use of narcotics, antihistamines
  • intoxication
  • alcohol
  • weakened immune systems
  • long-term use of immunosuppressant drugs
  • chemotherapy treatment for cancer
  • smoking
  • using inhaled corticosteroids
  • exposure to air pollution or toxic fumes
  • HIV/AIDS

Pneumonia - Prevention with vaccination

Yearly vaccination for seasonal flu can go a long way in the prevention of pneumonia in elderly. Influenza virus can predispose an elderly person for developing bacterial pneumonia. Influenza itself can move on to the lungs and cause viral pneumonia.

As for bacterial lung infection, doctors recommend a one-time shot of pneumococcal polysaccharide vaccine (PPSV) against Streptococcus pneumoniae for elderly people above 65 years. The prevention vaccination may have to be repeated after 5-6 years.

In the United States, PPSV is recommended for elderly people above 65 years of age as a prevention. Adults having symptoms of poor health and also long-term serious health problems are also advised to get vaccinated with PPSV as prevention. PPSV is recommended as prevention for smokers and children above two years of age having serious health problems. Adults and elderly people suffering from  asthma, COPD, congestive heart failure, Severe renal problems,  liver diseases, diabetes requiring medication, HIV/AIDS and asplenia do require vaccination as prevention and protection against pneumonia.

Very important: If an elderly person under your care appears to have symptoms like difficulty in breathing, cough, chest pain or lethargy immediately seek medical help without delay for proper treatment to prevent complications and save life.

Related topics in Daily Health News & Tips:
Pneumonia in children and infants - Signs, symptoms & causes.

Reference:
1. Höffken G, Halank M, Gillissen A. Treatment of severe pneumonia--community-acquired and "early onset" nosocomial Med Klin (Munich). 2004 Jul 15;99(7):362-71.
2. Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother. 2006 Apr;7(5):499-507.

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