Fitness - Loneliness and health - Loneliness in elderly

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Loneliness and elderly health Home > Loneliness and health - Loneliness in the elderly
Loneliness among elderly people has been connected to poor health, higher morbidity and mortality. Such feeling in the elderly may raise the potential for certain health risks including depression, suicidal tendency, increased stress, decreased memory, altered brain function, depressed immunity, high blood pressure and heart disease.

The meaning of loneliness

Loneliness may be defined as a lasting emotional state of estrangement, a feeling of being misunderstood, a feeling of rejection by others and lack of social partners for desired activities. This feeling often occurs in adolescents and aged people. However it is transient in adolescents. In elderly, it can lead to social isolation and reduced contacts with other people.

Loneliness and health of elderly

In the news release "Loneliness Linked to Serious Health Problems and Death Among Elderly" on June 18, 2012, Leland Kim (Senior Public Information Representative of University of California, San Francisco) informed that

Loneliness in elderly

"Loneliness — the unpleasant feeling of emptiness or desolation — can creep in and cause suffering to people at any age. But it can be especially debilitating to elderly and may predict serious health problems and even death, according to a new study by UCSF researchers ( Carla Perissinotto, MD, MHS et al)." The study found that only 18% persons above sixty years lived on their own. 43% of the elderly people surveyed suffered from loneliness. The study concluded that among the participants who were older than 60 years, it was a predictor of functional decline and death.

Regarding the health of people living in isolation, Michelle Mitchell, Charity Director General of Age UK said: "Living in isolation and loneliness is a stark reality for too many people in later life, and feelings of loneliness can have a significantly adverse effect on physical and mental well-being."

Causes of loneliness

Death of a life partner or a close friend, lack of companionship, chronic illness and lack of friends are the most common causes of seclusion. Lack of companionship and emotional support can cause elderly to internalize negative feelings which can compound the sense of isolation and affect their health. This feeling can affect both, mental and physical condition of the elderly people.
There is a well-established relationship between loneliness and aging. Natural aging process brings about a number of changes in a person. Decreased functional ability and efficiency impacts the health. The following aging related afflictions cause poor self-rating of health and seclusion:

• Decreased cardiac output
• Diminishing ability to respond to stress
• Loss of bone density
• Loss of muscle strength and size
• Decreased lung capacity
• Decreased gas exchange
• Degenerative diseases of joints
• Increased response time to stimuli
• Impaired vision
• Impaired hearing
• Cognitive decline
• Cognitive impairment
• Sleep disturbances
• Higher fatigue levels
• Decline of functional ability
• Reduced cerebral circulation affecting balance.

Coping with loneliness

With higher longevity coupled with reduced birth rates, the proportion of aged people in the population is increasing throughout the world. Immediate nationwide measures are required to reduce seclusion and isolation. Loneliness can be alleviated to a certain extent by activities, like reading, gardening, handcraft, light housework, television watching, keeping pets, attending social gathering or taking part in voluntary work.

Support from family and friends, regular contact with family, family involvement in their care and deep, engaging communication between the family members have immense positive effects in coping with loneliness. Forming groups to check the status of health of the elderly in the communities and neighborhood and involving young people in their care can go a long way towards mitigating their health problems and loneliness.

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References:
1. Leland Kim on June 18, 2012. Loneliness Linked to Serious Health Problems and Death Among Elderly. http://www.ucsf.edu/news/2012/06/12184/loneliness-linked-serious-health-problems-and-death-among-elderly.
2. Archana Singh and Nishi Misra. Loneliness, depression and sociability in old age. Ind Psychiatry J. 2009 Jan-Jun; 18(1): 51–55.
3. Age UK. Published on 28 September 2012 12:01 AM. http://www.ageuk.org.uk/latest-press/over-a-third-of-older-people-feel-lonely/

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Pneumonia in elderly people - Causes, symptoms & treatment

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Pneumonia in elderly people

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.

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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.

Current topic: Causes, symptoms and treatment of pneumonia in elderly people