What are the signs of pneumonia in the elderly?

Pneumonia can be tough to spot – because pneumonia shares a number of the same symptoms as other infections, such as the flu and bronchitis, it can be easy to misdiagnose your symptoms. Some of the signs of pneumonia include:

  • a cough, that may produce mucus (phlegm)
  • breathing difficulties, often shortness of breath
  • wheezing, or crackling and bubbling sounds when you inhale
  • chest discomfort or pain, especially when coughing or breathing
  • high temperature (fever)
  • sweating and shivering (chills)
  • feeling generally unwell or weak (malaise)
  • confusion, especially in the elderly

Pneumonia can cause serious health complications for elderly people, and can potentially be fatal. If you suspect that you, or someone else, has pneumonia then get in contact with a GP as soon as possible.

How do elderly people get pneumonia?

Community-acquired pneumonia – pneumonia caught without being in recent contact with a hospital or other healthcare premises is known as community-acquired pneumonia, which is the most common type of pneumonia. While most cases are caused by bacterial infections, pneumonia can also be commonly caused by viral infections such as the flu. Because elderly people are more susceptible to these types of infection, they are more likely to develop complications as a result - especially during flu season.

Hospital-acquired pneumonia – because of the high number of sick people in close proximity, contagious diseases and infections spread easily in hospitals. Sometimes these infections can cause a patient to develop pneumonia, especially in at-risk groups such as babies and the elderly. In the UK, pneumonia is the most common infection to get while in hospital.

Healthcare-associated pneumonia is similar to hospital-acquired pneumonia, and is developed during or shortly after contact with any healthcare facility such as nursing homes. The bacteria and viruses that spread in hospitals can be more resistant to drugs and are more aggressive, so pneumonia acquired in hospitals and healthcare facilities is more likely to be fatal than other types of pneumonia.

Aspiration pneumonia – sometimes materials, such as food matter or water, can be inhaled into the lungs by accident instead of being swallowed. You can also accidentally breathe in food, or acid that is brought up from your stomach. If this material isn’t cleared from the lungs by the body’s protective mechanisms, like coughing, then it may cause infection and inflammation of the lungs. Material inhaled through the mouth is more likely to contain bacteria which can cause an infection, and material been brought up from the stomach may be acidic and damage the lungs before an infection can develop.

Are elderly people more at-risk of pneumonia?

Weaker immune systems – the immune system tends to become weaker with age, meaning that the elderly are less able to fight off bacterial or viral infections that may cause pneumonia, and are also more likely to develop complications as a result of those infections.

Underlying health conditions – elderly people are more likely to have pre-existing health conditions that can make them more susceptible to pneumonia, such as diabetes or Parkinson’s disease. Medications used to treat some of these conditions may also suppress the immune system, making these people less capable of fighting off infections that may cause pneumonia.

Impaired breathing and swallowing – elderly people are more likely to develop health conditions that make swallowing difficult (dysphagia), which can increase the risk of inhaling materials into the lungs. Elderly people may also experience a reduction in the amount of saliva that they naturally produce, which can lead to a build-up of bacteria in the mouth. These factors can increase the risk of developing aspiration pneumonia.

Surgery and hospital stays – elderly people are the most likely group to develop health problems that require a stay in hospital or other healthcare facilities, and also spend longer periods of time during these stays than other age groups. Because of these factors, elderly people spend a longer amount of time in hospitals and other healthcare facilities, so they are more likely to be exposed to pneumonia-causing bacteria or viruses that spread in these environments.

How is pneumonia in the elderly treated?

Treatment for pneumonia is dependant on what type of infection caused the inflammation, and how severe the infection is. After a doctor diagnoses you, they will start you on the treatment that is most appropriate for your condition.

Viral pneumonia – a pneumonia caused by a viral infection typically has mild symptoms, and will normally go away without specific treatment. In most cases viral pneumonia can be recovered from at home with rest and painkillers.

Bacterial pneumonia – bacterial pneumonia is the most common type of pneumonia, and is often the most serious. The first line of treatment for mild bacterial pneumonia is antibiotics to be taken at home, which should start to improve your symptoms within 3 days. If symptoms do not improve, then it is important that you tell your GP as they may need to make changes to the treatment that has been prescribed, such as prescribing a different antibiotic to be taken on its own or alongside existing treatment or you may need to be treated in hospital.

Aspiration pneumonia – sometimes the material that has been accidentally inhaled, and is causing pneumonia, can be removed. If this is possible, a doctor may be able to use a medical instrument called a bronchoscope (a fibre-optic cable that is passed through the windpipe via the nose or mouth) to locate the material so it can be removed. This procedure, which is called a bronchoscopy, is done in hospital while under general anaesthetic. While in most cases material can be successfully removed during a bronchoscopy, if the material is deeply embedded and cannot be removed then surgery may be required to remove it.  Antibiotics may also need to be prescribed if there a concern about bacteria on the material causing an infection.

How do you prevent pneumonia in the elderly?

Get the pneumococcal vaccine – the pneumococcal vaccine protects against infections caused by the bacteria Streptococcus pneumoniae, which is the most common cause of bacterial pneumonia in the UK. The vaccination works by exposing your immune system to an inactivated form of the bacteria, so your immune system can start creating antibodies to protect you against future infections.

Because the bacteria is inactivated, the pneumococcal vaccine itself cannot infect you with the bacteria or cause pneumonia. The pneumococcal vaccine is offered to those who are 65 and above for free on the NHS, and is also available privately at Superdrug Health Clinics.

Get a flu jab – the influenza virus is a common cause of viral pneumonia, especially in winter months. The flu jab is the most effective way to protect yourself against infection during the flu season. Because the flu virus changes every year, you’ll need to get the flu jab even if you got one last year. Anyone over the age of 65 can get the flu jab for free on the NHS at any Superdrug Pharmacy. (link to SD.com store locator)

Stop smoking – directly smoking tobacco, or inhaling second-hand smoke, can damage your lungs and impair their function, which increases the risk that you will develop pneumonia (and other conditions such as lung cancer).

Practise good oral hygiene – bacteria from the mouth can be inhaled into the lungs, where it can cause an infection and inflammation. Making sure that your teeth or dentures are properly taken care of can help to reduce the chances of aspiration pneumonia caused by a buildup of bacteria in the mouth.

Keep your hands clean – bacteria and viruses can live on surfaces for extended periods of time, meaning that it’s easy to pick them up during day-to-day activities. Making sure that you wash your hands, preferably using antibacterial hand gels as well, reduces the chance that you will be infected by these organisms.