Pneumonia: A Dangerous Disease for the Elderly

Pneumonia may be caused by bacteria, viruses, or fungi, and results in inflammation and decreased circulation to one or both of the lungs. As circulation to the lungs decreases, oxygen in the blood declines. While cases of pneumonia can range from mild to severe, seniors are much more susceptible to this disease than average, healthy adults. Similarly, once they have this condition it takes them longer to recover from it, especially those who are frail who may require up to several months to return to health.

If you are a caregiver, it is essential to understand how to reduce the risk of pneumonia in seniors, and spot the symptoms should they occur.

Risk Reduction Strategies for Pneumonia in Seniors

• Frequent hand washing is very important. One of the reasons pneumonia is so common among seniors is that it can quickly spread in locations where they meet, such as senior centers, places of worship, or other social gathering places. Many germs and other microbes are spread through touch, and hand washing can dramatically reduce the spread of illness. It is a good idea to remind seniors to wash their hands regularly, especially in winter. At home, post signs above wash areas/sinks to remind the senior to wash his or her hands routinely and use hand sanitizer.
• Keep up with regular dental hygiene. Remind seniors about good dental care. Pneumonia can occur from tooth and gum infections, so daily brushing and flossing ─ or keeping dentures clean ─ is a must. Germ-killing mouthwash is also helpful.
• Immunizations are key. The Mayo Clinic and the National Heart, Lung and Blood Institute both advise seniors and anyone at risk for pneumonia to get vaccinated against bacterial pneumococcal pneumonia. It’s a one-time vaccine that can prevent or reduce the severity of pneumonia. His or her doctor may also recommend a booster vaccine after five years. It’s also a good idea to vaccinate seniors against other illnesses that can lead to pneumonia, particularly influenza.
• Talk to seniors about smoking. Smoking is a major risk factor for pneumonia. It greatly increases a person’s likelihood of getting the disease because it harms the ability of the lungs to defend against infection. Quitting smoking altogether can help at-risk seniors fend against pneumonia.
• Encourage good general health. Good overall health habits are critical to preventing pneumonia in seniors and keep the immune system strong enough to fight off infection. Help them follow appropriate nutritional guidelines for seniors (and any pre-existing conditions), and encourage them to get plenty of rest and physical exercise.

Be Familiar with the Symptoms of Pneumonia

The incidence of pneumonia increases with age, and seniors with pneumonia complain of fewer symptoms than do younger people. That’s why it is important that you be aware of the following symptoms:

• Coughing
• Chest pain
• Chills
• Fever
• Confusion
• Fatigue
• Shortness of breath
• Delirium
• Worsening of chronic confusion
• Falls

As soon as these symptoms appear, the senior should be taken to a doctor. Pneumonia is a serious illness, so it should be treated as such and strict standards should be maintained to help him or her prevent – or cope – with it.

Diagnosing and Treating Pneumonia in Seniors

Pneumonia represents the leading cause of infection-related death and the fifth cause of overall mortality, in the elderly. Several risk factors for acquiring pneumonia in older age have been reported, such as alcoholism, lung and heart diseases, nursing home residence and swallowing disorders. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related co-morbidities.

Many treatments for pneumonia are available. Treatment depends on the cause of your pneumonia, how severe your symptoms are, your age and overall health. Most healthy people recover from pneumonia in one to three weeks, but pneumonia can be life-threatening.

According to the Infectious Disease Society of America--Pneumonia in the elderly is a common and serious problem with a clinical presentation that can differ from that in younger patients. Older patients with pneumonia complain of significantly fewer symptoms than do younger patients, and delirium commonly occurs. Indeed, delirium may be the only manifestation of pneumonia in this group of patients. Alcoholism, asthma, immuno suppression, and age >70 years are risk factors for community-acquired pneumonia in the elderly. Among nursing home residents, the following are risk factors for pneumonia: advanced age, being male, difficulty in swallowing, inability to take oral medications, profound disability, bedridden state, and urinary incontinence. Streptococcus pneumonia is the most common cause of pneumonia among the elderly. Aspiration pneumonia is under diagnosed in this group of patients, and tuberculosis always should be considered. In this population an etiologic diagnosis is rarely available when antimicrobial therapy must be instituted. Use of the guidelines for treatment of pneumonia issued by the Infectious Diseases Society of America, with modification for treatment in the nursing home setting, is recommended.

Unfortunately, seniors who live in institutional settings such as hospitals and nursing homes are at higher risk of death from hospital-acquired pneumonia than others in the same age group, but there are a few things to keep in mind here. First of all, healthcare institutions tend to be places where sick people congregate so exposure to pneumonia is more of a risk in a hospital than it is in, say, the average grocery store. Additionally, many of the seniors who live in institutional settings are already suffering from another illness or have immune systems that are otherwise compromised. An otherwise healthy senior who moves into an assisted living facility isn’t likely to immediately contract pneumonia after she gets settled in her new home.

How Is Pneumonia Diagnosed?

According to the American Lung Association

• Physical exam: Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale. You also may be wheezing, and it may be hard to hear sounds of breathing in some areas of your chest.
• Chest X-ray (if your doctor suspects pneumonia).
• Some patients may need other tests, including:
• Blood test to check white blood cell count and to try to know the germ which may be in your blood as well.
• Arterial blood gases to see if enough oxygen is getting into your blood from the lungs.
• CT (or CAT) scan of the chest to get a better view of the lungs.
• Sputum tests to look for the organism (that can detect in the mucus collected from you after a deep cough) causing your symptoms.
• Pleural fluid culture if there is fluid in the space surrounding the lungs.
• Pulse oximetry to measure how much oxygen is moving through your bloodstream, done by simply attaching a small clip to your finger for a brief time.
• Bronchoscopy, a procedure used to look into the lungs' airways, which would be performed if you are hospitalized and antibiotics are not working well.

How Is Pneumonia Treated?

Treatment for pneumonia depends on the type of pneumonia you have and how severe it is, and if you have other chronic diseases. The goals of treatment are to cure the infection and prevent complications.

Most people can be treated at home by following these steps:

• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Get lots of rest. Have someone else do household chores.
• Do not take cough medicines without first talking to your doctor. Coughing is one way your body works to get rid of an infection. If your cough is preventing you from getting the rest you need, ask your doctor about steps you can take to get relief.
• Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.
• Make sure you take antibiotics as prescribed.

If your pneumonia becomes so severe that you are treated in the hospital, you may receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. You are more likely to be admitted to the hospital if you:

• Have another serious medical problem.
• Have severe symptoms.
• Are unable to care for yourself at home, or are unable to eat or drink.
• Are older than 65 or a young child.
• Have been taking antibiotics at home and are not getting better.

Viral Pneumonia: Typical antibiotics will not work for viral pneumonia; sometimes, however, your doctor may use antiviral medication. Viral pneumonia usually improves in one to three weeks.

Bacterial Pneumonia: Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin). Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary disease (which includes chronic bronchitis and emphysema), kidney disease, or diabetes are often given more powerful or higher dose antibiotics.

In addition to antibiotics, treatment includes: proper diet and oxygen to increase oxygen in the blood when needed. In some patients, medication to ease chest pain and to provide relief from a violent cough may be necessary.

Mycoplasma Pneumonia: These are pneumonia's caused by germs intermediate between viruses and bacteria. These are frequently mild, but occasionally can be severe and prolonged.

Recovering from Pneumonia

A healthy young person may feel back to normal within a week of recovery from pneumonia. For middle-aged or older people, it may be weeks before they regain their usual strength and feeling of well-being.

A person recovering from mycoplasma pneumonia may be weak for an extended period of time. Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Don't rush recovery!

If you have taken antibiotics, your doctor will want to make sure your chest X-ray becomes normal again after you finish the whole prescription. It may take many weeks for your X-ray to clear up.

Possible Pneumonia Complications

People who may be more likely to have complications from pneumonia include:

• Older adults or very young children.
• People whose immune system does not work well.
• People with other, serious medical problems such as diabetes or cirrhosis of the liver.

Possible complications include:

• Respiratory failure, which requires a breathing machine or ventilator.
• Sepsis, a condition in which there is uncontrolled inflammation in the body, which may lead to widespread organ failure.
• Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure.
• Lung abscesses - these are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.

Our Comfort Keepers can help the senior transition to home by shopping so there is adequate food in the house and can help the senior meet his or her dietary requirements through meal planning and preparation and by helping the senior to stay hydrated. They can also support the senior and help him or her be compliant with medical instructions through medication reminders and by providing transportation to and from follow-up appointments with the family physician. By closely monitoring the seniors under their care, Comfort Keepers can identify when symptoms are worsening and can alert their supervisors and the seniors’ families of the changing situation. They also help alleviate depression, which has been shown to decrease rates of readmission, through meaningful interaction with the seniors under their care and help them move about the home to reduce the risk of falls. Most importantly, our Comfort Keepers are able to assist recovering seniors with daily activities so they can focus on getting better and their families can have peace of mind knowing their loved ones are being cared for and supported.

Sources

Clinical Infectious Diseases, Volume 31, Issue 4, 1 October 2000, Pages 1066–1078,

Assisted Living Today. “Pneumonia in the Elderly – Simple Tips for Prevention and Treatment”. Web. 2015.

Oxford Journals: Clinical Infectious Diseases. “Community-Acquired Pneumonia in the Elderly” by

Thomas T. Yoshikawa. Web.

Medical News Today. “Top 10 Causes of Death in the US”. Web. 2015.

New York Times. Health Guide. “Pneumonia - Adults (Community Acquired)”. Monday, November 2, 2015.

American Lung Association