Pneumonia is the inflammation of the tissue in the lungs. It typically occurs due to an infection. Pneumonia in people aged 65 or older may become serious due to the higher risk of developing complications.
According to the American Lung Association (ALA), older adults have a higher chance of developing a severe illness related to pneumonia. This is because the immune system becomes less able to fight off the disease.
The United Kingdom’s National Health Service (NHS) state that it can develop suddenly over 1–2 days or come on slowly across several days.
This article explores pneumonia in older adults in more detail, including when to seek emergency help, symptoms, recovery, and risk factors.
Symptoms
According to a 2017 review, typical symptoms of pneumonia include:
- a cough, which may be dry, or produce phlegm
- breathing difficulties
- fever
- chest pain
However, the review states that these typical symptoms are unclear in older adults and may not present fully.
The ALA notes that older adults may present with fewer and milder symptoms, and perhaps a lower than normal temperature.
Symptoms of pneumonia in older adults may include:
- poor coordination, which may cause falls
- sudden change in day-to-day functioning
- reduced appetite
- incontinence
- confusion
- delirium
Bacterial pneumonia
Bacterial pneumonia is the most common form of the condition and can be more serious.
The ALA state that symptoms can develop suddenly or gradually. These symptoms include:
- a fever that can reach high temperatures, such as 105°F
- sweating
- increased breathing and pulse rate
- bluish lips and nailbeds
- confusion
Viral pneumonia
The ALA note that viral pneumonia symptoms develop over several days. Initially, a person may experience:
- fever
- dry cough
- headache
- muscle pain
- muscle weakness
After a day or two, symptoms worsen, and a person may experience:
- increased coughing
- shortness of breath
- muscle pain
- high fever
- blue lips
When to seek emergency care and medical help
Pneumonia can quickly become serious for older adults.
If a person suspects they, or an older relative, may have pneumonia, they should seek immediate medical advice.
If symptoms are severe or do not improve, an older adult may need to go to the hospital.
People should immediately contact emergency services if they experience:
- breathing difficulties
- a blue face or lips
- coughing up blood
- chest pain
- a high fever
- severe cough with mucus
- sweating and feeling cold, with paler, discolored or blotchy skin
- fainting or collapsing
- drowsiness or confusion
- a rash that does not fade after rolling a glass over it
Treatment
According to the ALA, in most cases, people with pneumonia can treat their symptoms at home, by:
- taking aspirin to help reduce a fever
- drinking plenty of fluids, both cold and warm
- using a humidifier or take a hot bath
- avoiding smoking and second-hand smoke
- getting plenty of rest
A person should not take cough medicine unless a doctor recommends this course of action.
If the cause of the pneumonia is bacterial, a doctor will prescribe antibiotics. People must complete the whole course of antibiotics even if they feel better, as stopping early could trigger the infection again.
If an older adult requires hospitalization due to pneumonia, they may need oxygen therapy, as well as an intravenous (IV) drip to receive fluids.
Recovery
Recovery of pneumonia in older adults can be a long process. According to one 2017 article, although some recover in 6 weeks, it may take as long as 12 weeks for others.
It is important to rest for as long as possible during recovery.
The British Lung Foundation suggests the following recovery timeline:
| Length of time | What to expect |
| 1 week | The fever should have resolved. |
| 4 weeks | The chest will feel better, and a person will produce less mucus. |
| 6 weeks | A person will cough less often and find it easier to breathe. |
| 3 months | Most symptoms should have gone, although people might still feel fatigue. |
| 6 months | A person may feel back to normal. |
Prevention
There is no sure way to prevent pneumonia. However, people can help reduce their chances of developing the condition with the following:
- Hand hygiene: A person should regularly wash their hands to remove any germs.
- Quit smoking: A systematic review of tobacco smoking on developing pneumonia in the community highlights a strong association between them. This suggests those who smoke are at higher risk of the condition.
Vaccinations
The Centers for Disease Control and Prevention (CDC) state that a person over the age of 65 has the option of two vaccines: the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13).
The CDC recommend that all adults aged 65 or over get the PPSV223 shot.
The PCV13 shot is suitable for those aged 65 or older, who have:
- a cochlear implant
- cerebrospinal fluid leak
- conditions that weaken the immune system
It is important to note that people can not get both shots at the same time.
If a healthcare professional recommends getting both, get the PCV13 shot first. A doctor can advise when to return for the second shot.
Causes and risk factors
Sometimes, older adults may develop pneumonia following a stay in the hospital. In these cases, a healthcare professional may refer to it as hospital-acquired pneumonia.
However, people can also catch pneumonia in the community. People may refer to this as community-acquired pneumonia.
Causes of pneumonia include:
- Bacteria: Pneumococcal pneumonia is the most common type of bacterial pneumonia. It can develop after a person has a viral cold or the flu.
- Viruses: The influenza virus is a common cause of viral pneumonia. The virus enters the lungs and multiplies.
- Fungi: Fungal pneumonia occurs when people expose themselves to fungi from bird droppings or contaminated soil.
As well as age, other risk factors of pneumonia include:
- smoking
- previous stroke
- neurological disorders, such as dementia, epilepsy, and Parkinson’s disease
- dysphagia, or difficulty swallowing
- history of respiratory disease
- diabetes
- cancer
- chronic liver disease
Complications
Older adults have a higher chance of developing complications from pneumonia. Examples of these include:
- Pleurisy: A condition where the pleura becomes inflamed. The pleura are the two large layers of tissue that separate the lungs from the chest wall. Pleurisy can cause respiratory failure.
- Lung abscess: Where tissue on the lung dies and pus develops in the resulting space. This is a rare complication and may occur in people who have a history of alcohol misuse or pre-existing serious illnesses.
- Sepsis: In relation to pneumonia, the infection in the lungs may trigger a potentially life threatening immune response in other parts of the body.
- Acute respiratory distress syndrome (ARDS): A severe form of respiratory failure.
Summary
Pneumonia is an inflammation of the lungs that may occur due to viral, bacterial, or fungal infections.
Older adults have a higher chance of developing complications of severe pneumonia. If a person suspects they, or an older adult, have pneumonia, they should seek immediate medical help.
If treatment starts early, this increases the chances of recovery and reduces the risk of complications.
Q:
What is the prognosis and outlook for those over the age of 65 with pneumonia?
A:
The incidence of community-acquired pneumonia in older adults is about four times higher than in the general population. Often, they will require hospitalization and supplemental oxygen. This helps improve some major outcomes, including the length of stay or the need for invasive procedures such as mechanical ventilation.
Mortality is higher among the elderly and age is an independent risk factor. Comorbidities may contribute to worse outcomes, particularly with underlying lung disease or malignancy.
Michael Virata, MD
Leave a Reply