According to the American Thoracic Society, approximately 1 million adults seek hospital care for pneumonia each year. Young, healthy people usually make a full recovery, but pneumonia in the elderly can be very serious—even deadly. In fact, the Centers for Disease Control and Prevention (CDC), ranks pneumonia as one of the top 10 leading causes of death in the United States. Despite the prevalence of this disease, many seniors and their caregivers don't know all the facts about pneumonia.

What Is Pneumonia?

Pneumonia is an infection of the lungs that can be caused by bacteria, viruses and fungi. Pneumococcal pneumonia is caused by the Streptococcus pneumoniae bacteria and is the most common form of pneumonia. However, viruses that infect the upper respiratory tract like the flu, the common cold (rhinovirus) and Coronavirus (COVID-19) can cause viral pneumonia and even lead to a secondary bacterial infection of the lungs as well.

The types of bacteria that cause pneumonia and the respiratory viruses than can lead to pneumonia are contagious. According to the CDC, pneumonia is spread through direct person-to-person contact via respiratory droplets. However, it is important to note that most people already have Streptococcus pneumoniae and other variations of this bacteria living in their respiratory tract. Although pneumonia is contagious, the main way older people get it is actually from themselves.

“All of us carry bacteria in our throats and noses,” explains William Schaffner, M.D., medical director of the National Foundation for Infectious Diseases and professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. “Frail elders often can’t clear secretions from their lungs, and those secretions tend to go down into the bronchial tubes. The area fills with pus, mucous and other liquids, preventing the lungs from functioning properly. This means oxygen cannot reach the blood and the cells of the body. Complications of pneumonia may include bacterial infection in the bloodstream (sepsis) and fluid and infection around the lungs.”

Why Are Older Adults More Prone to Pneumonia?

Frailty

Older people are simply more frail than younger individuals are. Frailty doesn’t boil down to a single disease or diagnosis, though. One study defines this condition as “a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.” For example, a common marker of frailty in seniors is muscular weakness, which can directly affect an elder’s ability to effectively clear secretions from the lungs and avoid infection. Other indicators of frailty include unintentional weight loss (10 pounds in the past year), self-reported exhaustion, slow walking speed and low physical activity.

Weakened Immune Systems

Our immune systems weaken as we age, therefore seniors may have a harder time fighting off infections like pneumonia. Some drugs, such as steroids and chemotherapy, can suppress immune responses further. Smoking cigarettes and excessive alcohol consumption can impact immune function as well.

Age-Related Health Conditions

Seniors may have other chronic medical conditions that increase the risk of developing pneumonia, such as diabetes, Parkinson's disease, dementia and heart disease. Lung conditions like cystic fibrosis, asthma, emphysema, COPD (chronic obstructive pulmonary disease) and bronchiectasis contribute significantly to this risk.

Surgery

Seniors who have had surgery are more susceptible to pneumonia since their bodies are already working hard to heal. Pain medications are usually prescribed following surgical procedures, but they can cause patients to take shallower breaths, which contributes to mucus gathering in the lungs. The same applies to sedative medications and anesthesia.

Signs of Pneumonia in Elderly Adults

If any of the following symptoms present in a senior, it is crucial to see a doctor as soon as possible. However, it’s important to note that older individuals may experience different symptoms of infection compared to younger individuals.

  • Coughing
  • Fever
  • Chills
  • Sweating
  • Shortness of breath
  • Chest pain
  • Green, yellow or bloody sputum that comes up when coughing
  • Feeling lethargic
  • Fast, shallow breathing
  • Suddenly feeling worse following a recent cold or bout of flu
  • Confusion or changes in behavior
  • Loss of appetite
  • Blue lips or fingernails due to a drop in blood oxygen level

Be aware that it is possible for seniors to contract a milder version of pneumonia (often referred to as “walking pneumonia” or atypical pneumonia). Symptoms of walking pneumonia can be so mild that a senior or their caregiver may not even notice them.


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Treatments for Pneumonia

A doctor will determine if a senior has pneumonia using chest X-rays and a blood test. Bacterial pneumonia is typically treated with antibiotics, but if the infection is viral, the doctor may prescribe an anti-viral medicine. Make sure your loved one closely follows the doctor’s instructions for taking these prescriptions. Even if they begin feeling better before finishing the medicine, they should continue taking it as prescribed. If they stop too soon, the infection may come back. Recurrent pneumonia can be difficult to treat.

Doctors may also administer fluids if a patient is dehydrated, oxygen therapy if they are having trouble breathing or their blood oxygen level drops, medication for pain relief, and additional medical support as needed.

“Milder cases of pneumonia can be cared for at home, but more severe cases, especially in patients with other underlying health conditions, may require hospitalization,” Dr. Schaffner says. Family caregivers can help their loved ones through the healing process by ensuring they consume plenty of fluids and stick to a healthy diet.

Complications of Pneumonia

Pneumonia can be mild but it can also become very severe—even life-threatening. If a case of pneumonia is not treated promptly, bacteria can migrate from the lungs to the blood causing a condition called bacteremia. The body may mount a serious reaction against the blood infection called sepsis. The most common infections that trigger sepsis among the elderly population are respiratory infections, such as pneumonia.

Sepsis is considered a medical emergency and older adults are at an increased risk of death. Signs of sepsis include sudden changes in mental status, a drop in blood pressure and a change in respiratory rate. If signs of sepsis occur, it is important to seek emergency medical care immediately. Other complications include pleural effusions, empyema, pleurisy, lung abscesses, renal failure and respiratory failure.

How to Prevent Pneumonia in Elderly Loved Ones

The key to preventing complications like sepsis is preventing infections like pneumonia from occurring in the first place. Since influenza predisposes elderly people to pneumonia, the number of cases tends to spike during flu season. Dr. Schaffner recommends that all people over age 65 get an annual flu shot as well as a pneumococcal vaccine. This one-time shot protects against the Streptococcus pneumoniae bacteria.

Caregivers and other family members should also be vaccinated to avoid getting sick themselves and passing the illness to their loved ones. “The CDC recommends that anyone who has prolonged contact with an elderly person should get vaccinated,” urges Dr. Schaffner.

In addition to staying current with vaccines, a healthy lifestyle plays a critical role in preventing pneumonia. Quitting smoking, practicing good oral hygiene, exercising regularly and maintaining a healthy weight through a nutritious diet can all help boost a senior’s immune system and stave off diseases. Of course, good hand-washing habits are another strong defense.

It is important for family caregivers to educate themselves on pneumonia and other medical conditions that commonly affect seniors. This information will give you added peace of mind that you are doing as much as you can to keep your loved one healthy.

Sources: American Thoracic Society: Top Pneumonia Facts—2018 (https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf); Centers for Disease Control and Prevention Fast Stats—Deaths and Mortality (https://www.cdc.gov/nchs/fastats/deaths.htm); National Heart, Lung, and Blood Institute—Pneumonia (https://www.nhlbi.nih.gov/health-topics/pneumonia); American Lung Association: What Causes Pneumonia? (https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/what-causes-pneumonia.html); Pneumococcal Disease: Streptococcus pneumoniae (https://www.cdc.gov/pneumococcal/clinicians/streptococcus-pneumoniae.html); The Frailty Syndrome: Definition and Natural History (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028599/); Frailty in older adults: evidence for a phenotype. (https://www.ncbi.nlm.nih.gov/pubmed/11253156/); Cleveland Clinic: Atypical (Walking) Pneumonia (https://my.clevelandclinic.org/health/diseases/15744-pneumonia-atypical-walking-pneumonia)