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Pneumonia is an infection where the tiny air sacs in your lungs (alveoli) become inflamed. This can lead to symptoms such as cough and shortness of breath.

Pneumonia can be serious for some groups, one of which is older adults. In fact, a recent study estimated that almost 1 million adults ages 65 years or over are hospitalized with pneumonia each year in the United States.

There are a couple reasons why pneumonia can be more severe in older adults:

Keep reading as we discuss pneumonia in older adults, diving deeper into its symptoms, causes, and treatment.

The symptoms of pneumonia in older individuals can differ from those in other age groups.

Older adults with pneumonia may be more likely to:

  • feel weak or unsteady, which can increase the risk of falling
  • be without a fever or have a body temperature that’s lower than normal
  • experience confusion or delirium
  • have changes in functional status, which is the ability to perform daily activities
  • experience urinary incontinence
  • lack an appetite
  • experience a worsening of existing health conditions

Since symptoms in older adults are often more subtle and can differ from classic pneumonia symptoms, pneumonia can be more difficult to recognize in this population. This can potentially result in a delay in diagnosis and treatment.

What are the classic symptoms of pneumonia?

Even though older adults often have different pneumonia symptoms, they can also experience some of the more classic symptoms of pneumonia as well. These may include:

Generally speaking, the causes of pneumonia can be classified in two ways:

  1. where it was acquired
  2. what type of germ is causing it

Let’s explore each of these in more detail below and how they may relate to pneumonia in older adults.

Where can you acquire pneumonia?

You can get pneumonia from a variety of different places, which include:

  • Community-acquired pneumonia (CAP). This is pneumonia that you get outside of a hospital or healthcare facility. It’s estimated that CAP is the third most common cause of hospitalization in people ages 65 years and older.
  • Healthcare-associated pneumonia. This is pneumonia that you acquire while in a healthcare facility. Older adults who are hospitalized or in a long-term care facility may be at an increased risk for this type of pneumonia.
  • Aspiration pneumonia. This happens when you inhale things like food, saliva, or vomit into your lungs. Older individuals with swallowing disorders can be at higher risk for developing this type of pneumonia.

What germs cause pneumonia?

Pneumonia can be caused by a variety of germs, including bacteria, viruses, and fungi. Bacteria are one of the most common causes of pneumonia in adults.

The exact type of germs that cause pneumonia in older adults can vary.

One review from 2014 found that the following types of germs were more frequently isolated from adults with CAP who were ages 65 years and older:

  • Streptococcus pneumoniae, a type of bacteria
  • Haemophilus influenzae, another type of bacteria
  • respiratory viruses, which can include viruses that cause colds, the flu, and (most recently) COVID-19

Pneumonia can quickly become serious in higher risk groups, such as older adults. Because of this, early detection is very important. Some signs require a trip to the doctor, including:

  • trouble breathing
  • nails, face, or lips that have a bluish color
  • chest pain
  • abnormal body temperature, such as a high fever or a temperature that’s lower than normal
  • new confusion, delirium, or changes in functional status

How is pneumonia diagnosed?

Pneumonia in older adults can be difficult to diagnose. Your doctor will first request your medical history in which you may be asked things such as:

  • your symptoms
  • any underlying health conditions
  • medications or supplements that you’re taking
  • your smoking history
  • whether you’ve received your pneumococcal or influenza vaccinations

Your doctor will then perform a physical examination. They’ll check vital signs, including blood pressure, heart rate, and blood oxygen levels. They may also use a stethoscope to listen for crackling sounds in your lungs.

In order to make a diagnosis, your doctor may also order the following:

  • Blood tests. These tests involve taking a blood sample from a vein in your arm. The results can help indicate the presence of an infection.
  • Imaging. Your doctor order imaging technology such as X-ray or CT scan to visualize your chest and lungs.
  • Culture. Cultures can be taken from sputum or pleural fluid to help determine what type of germ may be causing your infection.
  • Pulse oximetry. Pneumonia can affect the amount of oxygen that you can take in. This test measures the amount of oxygen in your blood.
  • RT-PCR testing. Your doctor will likely test for COVID-19 and the flu if you have an upper respiratory infection or pneumonia-like symptoms.

Some cases of pneumonia in older adults can be treated at home. However, depending on your symptoms and overall health, it’s also possible that you may be hospitalized.

Antibiotics are used to treat pneumonia that’s caused by bacteria. The types of antibiotics used can depend on the type of bacteria causing the infection and on the infection’s severity. They may be given orally or by IV.

Some examples of antibiotics used for pneumonia can include one or a combination of the following:

  • macrolides
  • fluoroquinolones
  • beta-lactams

Viruses can’t be treated with antibiotics.

Treatment of viral pneumonia focuses on supportive care, such as easing symptoms, maintaining hydration, and monitoring vital signs. In some cases, antiviral drugs may be used.

In the case of the flu, an antiviral, such as Tamiflu, may be prescribed.

What other treatments may be recommended?

Additional treatments that may be used for pneumonia include:

  • Fluids. It’s important to make sure that you have adequate fluid intake when you’re sick with pneumonia. If you’re hospitalized, you may receive fluids by IV.
  • Oxygen therapy. If you’re hospitalized with pneumonia, oxygen therapy may be used to make sure that you’re receiving enough oxygen.
  • Rest. Getting plenty of rest can help your body respond to the infection. If you must perform daily activities, try not to overdo it and don’t hesitate to ask for help, if necessary.
  • Use heat and humidity. Drinking warm beverages or broths and using a humidifier may help to loosen mucus in your throat and chest.
  • Over-the-counter (OTC) medications. These can help ease symptoms like fever and discomfort. Examples include things like acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Aleve).

Pneumonia in people ages 65 years or older is associated with an increased risk of hospitalization and mortality when compared to other age groups. Symptoms can also be atypical and can quickly worsen.

Because of this, seeking prompt medical attention is essential in promoting a positive outlook.

The recovery period for pneumonia can vary based on the severity of your illness. It’s possible that your symptoms may get better after a period of days or weeks.

However, in some people, the recovery period may be longer.

In order to improve outcome, it’s important that older adults who’ve had pneumonia pay close attention to the following during their recovery period:

  • nutrition
  • fluid intake
  • getting enough rest
  • managing underlying health conditions

Keep in mind that pneumonia may also recur.

One study of 2,709 people hospitalized with CAP found that pneumonia recurred in 9 percent of participants over a period of 5 years. Recurrence was associated with reduced functional status.

What are the complications from pneumonia?

There are several potential complications from pneumonia. These are more common in higher risk groups, which include older adults, and can include:

If you’re an older individual, you can help to prevent pneumonia by doing the following:

  • Getting the pneumococcal vaccine. This helps to prevent pneumonia due to S. pneumoniae. There are two pneumococcal vaccines for adults ages 65 years and older — PPSV23 and PCV13. Ask your doctor about which one is recommended for you. You may qualify for a pneumococcal vaccine before age 65 if you have a weakened immune system or chronic lung, kidney, or heart conditions.
  • Getting the influenza vaccine each year. Pneumonia is a potential complication of the flu, so be sure to get your flu vaccine each year. There’s a high-dose flu vaccine that’s specially formulated for adults ages 65 years and older.
  • Washing your hands regularly. Practicing good hand hygiene can help prevent many types of infections.
  • Avoiding smoking. Smoking is damaging to your lungs and can make it harder to fight off a respiratory infection.
  • Making healthy lifestyle choices. Things like eating a balanced diet, regular exercise, and getting enough sleep are all good for your overall health and also help keep your immune system strong.

Pneumonia is an infection that’s often more severe in older adults. It’s a significant cause of hospitalization and mortality in this population.

The symptoms of pneumonia in older individuals often differ from other age groups. Older adults are more likely to have symptoms such as:

  • lower body temperature
  • confusion
  • changes in functional status

Prompt medical attention is vital for improving the outlook of pneumonia in older adults.

See your doctor if you or a loved one experiences:

  • difficulty breathing
  • new confusion
  • chest pain