Many years ago, my elderly friend Delphine was rushed by ambulance to the emergency room because a slight cold suddenly turned worse and she began acting confused. The doctor listened to her lungs and ordered a chest x-ray, which showed she had pneumonia. I had visited her in the nursing home just a few days earlier and she seemed fine.
Pneumonia happens when viruses, bacteria or fungi infect the lungs. Normally, the body can filter out most germs before they reach the lungs or if they make it there, the body’s immune system can get rid of them. If the infection can’t be controlled, eventually oxygen levels drop, which can cause confusion, coma, heart failure and death.
Every year in the United States, about one million people are hospitalized with pneumonia and about 50,000 people die — most of them adults.
Anybody can develop pneumonia, but two groups of people are at highest risk:
- Infants 2 years old or younger (because their immune systems are still developing during the first few years of life)
- People 65 years old or older (because our immune systems weaken as we age)
Certain conditions and diseases can increase your risk, including
- Cystic fibrosis
- Heart Failure
- Sickle cell anema
- Weakened or suppressed immune system
If you have trouble coughing or swallowing, smoke, abuse alcohol, are undernourished, recently had a cold or the flu, or were exposed to certain chemicals, pollutants or toxic fumes, you’re also at increased risk.
Delphine’s primary risks were her age and her recent cold.
COMMON PNEUMONIA SYMPTOMS
- General feeling of weakness
- Cough — yellowish, greenish or blood mucus
- Shortness of breath
- Chest pain
- Chills or excessive sweating
The challenge with elderly people is that they often don’t have any of the more common symptoms, or if they do, they’ll have fewer and/or milder symptoms. For instance, they may not have a fever or their cough will be dry instead of productive. It is not at all unusual for them to act confused or delirious. Delirium is a sudden change in a person’s mental state; it can happen over several hours or several days.
HOW TO PREVENT PNEUMONIA IN THE ELDERLY
- Pay attention to symptoms like weakness, confusion or delirium, especially if the person has a cold or the flu
- Wash your hands regularly with soap and water
- Keep your own germs to yourself. Sneeze or cough into the inner crook of your elbow. Stay away from other people if you are sick.
- Don’t smoke
- Get a seasonal flu shot
- If 65 or older, get a pneumonia vaccine. The CDC now recommends two vaccines to protect older adults against bacterial pneumonia — Pneumovax and Prevnar 13, for extra protection. They should not e given at the same time.
The treatment of pneumonia depends on what caused the infection. If it’s bacterial pneumonia, antibiotics are the usual treatment. Antibiotics aren’t effective against viral pneumonia, but depending on the type of virus that caused it, an antiviral medication can help if it’s started early enough. Antifungal medications are used to treat most fungal pneumonias.
Most people begin to improve within days of starting treatment, but the more frail or elderly a person is, the higher the risk that complications will occur and that he or she will die.
Unfortunately, my friend Delphine died in the hospital the morning after she was admitted. It was only after, when I asked the doctor how it could have happened so quickly, that I learned how subtle the signs and symptoms of pneumonia can be in an elderly person. It was a difficult lesson to learn and one I’ve never forgotten.
If you would like to learn more about pneumonia, Advantage Home Care provides patient education materials to its clients. Check out the website for a complete list of services.
Our Aging in Place blog is written by Diane Atwood, who also writes the blog Catching Health with Diane Atwood.