Pneumonia in the Elderly

According to the Centers for Disease Control and Prevention, an estimated 900,000 Americans get pneumonia each year, and adults over 65 are more likely to be among them. In fact, the disease continues to be one of the leading causes of death among seniors.

Pneumonia, especially if diagnosed early responds well to treatment. But even with the best health care services, pneumonia continues to kill 40,000 to 70,000 Americans each year. The chances of older adults fully recovering from pneumonia is lower compared to the younger population. Even seniors who were able to recover have a higher chance of dying over the next several years.

Image by Wanderlinse on Flickr

Pneumonia Risk Factors in the Elderly

Age is a major risk factor for developing pneumonia. Adults age 65 and older continues to be one of the hardest hit sectors of the population. It is the most common infectious cause of death and responsible for millions of hospitalizations yearly. Numbers coming from the National Hospital Discharge Survey in the US has placed the number of hospitalizations for age 65 or older at 21.4 million between 1990 and 2002. More alarming is the fact that 70 percent of those hospitalized for pneumonia are from the senior population.

Age – Seniors age 65 or older are at high risk for acquiring pneumonia. A weaker immune system and especially those suffering from medical conditions are at great risk developing pneumonia.

Diseases – Diseases that compromise or weaken the immune system such as HIV/ AIDS and chronic illnesses such as lung disease, emphysema and heart disease increases the risk for developing pneumonia.

Immune System Weakening Treatments – People undergoing chemotherapy or any treatment that negatively affects the immune system such as immune suppressant drugs are at high risk for developing the disease.

Exposure to Chemicals and Pollutants – seniors who are constantly exposed to chemicals at home or in the workplace are in danger of acquiring uncommon types of pneumonia. The risk is particularly high for seniors who work with chemicals and fertilizers in their gardens.

Unhealthy Lifestyle Habits – Smoking exposes your body to harmful chemicals and diseases causing toxins. It weakens the immune system especially on seniors who are already suffering from compromised immune systems. Seniors who live more active lifestyles are also at less risk for developing pneumonia.

Pneumonia by Origin of Infection

Pneumonia may be classified according to where the infection was acquired or its causative agent. Doctors often classify pneumonia based on its origin of infection. This makes it easier for them to identify the likely cause of infection and symptoms associated with the disease.

Community-Acquired Pneumonia (CAP) – The American Academy of Family Physicians defines CAP as a pneumonia not acquired in a hospital or long-term care facility. This usually follows a viral infection such as flu. This makes treatment of common colds and flu important to prevent its progression towards pneumonia.

Pneumonia Acquired from an Institutional Setting – This includes pneumonia acquired from a hospital or long-term setting. Senior living assisted facilities, long-term care or senior homes are also included in this category. Seniors are in great risk for acquiring pneumonia through this setting due to a weaker immune system. Infecting agents are also more virulent compared to those found in the community setting.

Compared to community-acquired pneumonia, hospital-acquired and healthcare-acquired pneumonia are controllable. Medical and long-term care personnel are in a better position to control healthcare settings thereby reducing the risk for infection.

Pneumonia in the Elderly

The difficulty with diagnosing pneumonia is that many of its early symptoms can be mistaken for the common cold or flu. According to an Oxford Journal on Aging and infectious diseases, pneumonia in the elderly may present itself with few respiratory symptoms and signs and instead may be manifest as delirium, worsening of chronic confusion, and falls. Delirium or acute confusion was also found in 44 percent of those suffering from pneumonia. Falls may also indicate that a person is ill or severely weakened.


Older adults with pneumonia may not show traditional symptoms of pneumonia. Symptoms might be milder, different or fewer. Seniors with pneumonia may not suffer from fevers or have nonproductive cough (coughing without sputum).  Symptoms that are commonly seen in seniors include confusion or delirium. Chronic illnesses or a lingering cough are also clear indications that the elderly is already suffering from pneumonia.

  • Cough – yellowish, greenish or bloody mucus
  • Mild or high fevers
  • Chills
  • Shortness of breath especially when performing strenuous activities
  • Sharp stabbing pain when coughing or breathing deeply
  • Headaches and migraines
  • Excessive sweating
  • Loss of appetite
  • General body weakness
  • Confusion especially in the elderly

Symptoms may vary according to the type of infection. Pneumonia caused by bacteria may cause high fevers (as high as 105 degrees F). Other symptoms may include rapid and shallow breathing. Poor blood circulation can cause bluish lips and nail beds, a clear indication that oxygen is not reaching these areas. Bacterial pneumonia may also affect the person’s mental status causing confusion or delirium.

Initial symptoms of viral pneumonia are similar to influenza. Symptoms include fever, headaches, dry cough, weakness and muscle pain. The next 12 to 36 hours shows difficulty in breathing, worsening cough with small amounts mucus. Blood circulation is also impaired with bluishness seen in the lips and nail beds of the patient.

Diagnosis of Pneumonia in the Elderly

Chronic illnesses such as colds and flu in the elderly are tell-tale symptoms that the individual might be suffering from a major disease. Common colds should be treated immediately to prevent it from developing into pneumonia.

Seniors suspected of suffering from pneumonia are advised to consult with their doctors and discouraged from self medicating. Simple diagnosis is done by first letting the doctor listen to the senior’s lungs. An infection is suspected when the doctors hear rales, rattling or bubbling sounds. This is a clear indication of infection and additional tests are advised to identify the illness.

When infection is suspected, pulse oximetry tests are used to compute blood oxygen levels to determine lung functioning. CT scans or chest x-rays are then recommended to determine the area of infection and degree of illness. A blood or sputum test is used to determine the specific agent responsible for infection.

Preventing Pneumonia in the Elderly

Pneumonia’s main mode of transmission is through direct contact with people who are ill. It could also be transmitted through respiratory droplets from the nose or mouth. Preventing the spread of infection could easily be done by being proactive and ensuring that seniors are not exposed to the illness. This is especially true for seniors who are at long-term care and hospital settings where the medical team exercises full control over the environment.

Eating healthy and living an active lifestyle goes a long way in helping seniors boost their natural immune system. Exposure to pneumonia infective agents could not be totally eliminated but ensuring that seniors are at their optimum health is an achievable goal.

Seniors are at high risk for developing pneumonia. Underlying medical conditions and a weak immune system makes them susceptible to infection. Simple antiseptic techniques such as washing your hands before handling a senior’s personal things dramatically reduce the spread of infection. Good oral hygiene should also be practiced to prevent infection.

Senior Pneumonia Vaccinations – A Quick Look into the Numbers

Image by Lance McCord on Flickr

Almost 65 percent of Americans age 65 and older have been vaccinated against pneumonia. According to the Agency for Healthcare Research and Quality, 2000 to 2008 saw the numbers of seniors vaccinated against pneumonia increase from 53 to 60 percent. The 2010 National Healthcare quality Report which examines the nation’s access to and quality of healthcare showed that:

  • 65 percent or two thirds of high-income seniors have been vaccinated against pneumonia while 46 percent or less than half of poor seniors have received similar treatment.
  • Seniors living in a large inner-city area where a majority of the population were low-income and minorities only had 52 percent vaccinated against pneumonia. However, seniors living in medium-size cities reported that 64 percent of them had undergone vaccination.
  • 65 percent of white seniors were vaccinated against pneumonia compare to 45 percent for Asian and Black seniors. Hispanic seniors were at the bottom of the list with only 37 percent of them vaccinated against pneumonia.

Pneumonia continues to be one of the leading causes of hospitalization and death in the elderly. Preventing pneumonia in the elderly should always be a priority among family members and long term care providers. So the next time you suspect your love one is suffering from the early symptoms of pneumonia, consulting with a medical professional gives your love ones the best chance of full recovery.

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