Pneumonia is an infection that attacks one or both lungs of people, including the elderly. As you age, your immune system weakens and tends to infect all kinds of bacteria and viruses. Bacteria are a common cause of this lung infection in adults. Pneumonia in the elderly can easily become serious, so prompt treatment is essential. The problem with spotting the signs of this infection in older adults is that classic symptoms like fever and cough are usually not present. On World Pneumonia Day, celebrated annually on November 12, we inform you about the symptoms and treatment options.

What is pneumonia?

It’s a serious lung infection which causes inflammation of the air sacs (alveoli) of the lungs. “The alveoli can fill with fluid or pus and cause symptoms like cough and fever. It can affect people of all ages, but it is particularly dangerous for older people due to a weakened immune system and other underlying health problems,” explains the pulmonologist. Dr Pooja Bajaj.

It can be caused by different types of bacteria, fungi and viruses, but bacteria is one of the most common causes of this infection in adults, according to the United States. National Heart, Lung, and Blood Institute. Bacterial pneumonia, the most common form, often affects only one part of the lung, depending on the American Lung Association. There are four stages of pneumonia:

• Congestion: The alveoli fill with fluid, causing a mild cough and fatigue.
• Red hepatization: Inflammation increases and the lungs appear red and firm. Symptoms get worse, with a more severe cough and fever.
• Gray hepatization: The immune response continues and the lungs appear gray due to the breakdown of red blood cells.
• Resolution: The body begins to resolve the infection and symptoms gradually improve.

What are the symptoms of pneumonia in older people?

Fever or a cough accompanied by phlegm are typical symptoms of pneumonia. But older people with this infection generally do not show these signs, according to a study published in the United States. National Library of Medicine in 2021. Possible signs of pneumonia in older adults may include:

• Growing confusion
• Temporary unconsciousness
• Shortness of breath
• Rapid breathing, which is more than 30 breaths per minute
• A racing heart with a pulse greater than 120 beats per minute
• Circulation problems with loss of blood pressure (a systolic reading below 90 millimeters of mercury or a diastolic reading below 60 mmHg)

“In cases of pneumonia in older adults, pre-existing health conditions may also worsen,” says Dr. Bajaj. Elderly people with underlying chronic illnesses such as heart problems, chronic obstructive pulmonary diseasediabetes or chronic kidney disease should consult a doctor immediately if they suffer from this infection.

Pneumonia in the elderly: knowing if they can survive it

“Yes, older people can survive pneumonia, but the prognosis depends on factors such as the severity of the infection, underlying health problems and the timeliness of treatment,” says the expert. Pneumonia in the elderly occurs quickly and the prognosis is poor. The death rate from severe pneumonia among older adults is about 20 percent, according to a 2015 study published in the International Journal of Clinical and Experimental Medicine.

Another study, involving 803 pneumonia patients with an average age of 84, showed that one in five patients died during their hospital stay. During the year-long study, published in the European geriatric medicine journal in February 2024, it was also found that a quarter of survivors were released with increased dependence on their families. Nearly half of the survivors died over the next year. Pneumonia in older people can be serious and fatal due to the following factors:

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• Aging weakens the immune system and reduces the body’s ability to fight infections.
• “Chronic health problems like heart disease and COPD make the lungs more susceptible to infections,” explains the expert.
• Being bedridden or on a ventilator increases the risk of hospital-acquired pneumonia.
• Difficulty swallowing can lead to aspiration pneumonia, where food or liquid enters the lungs.

What are the ways to treat pneumonia in the elderly?

Treatment of pneumonia in elderly patients includes:

1. Antibiotic therapy

It is tailored to people depending on the severity of the infection. “As an outpatient, amoxicillin or doxycycline are administered. In the event of hospitalization, a combination of antibiotics such as ceftriaxone and azithromycin is prescribed,” explains the expert. It is important to complete the full course of these medications to ensure that the pneumonia is completely treated.

2. Oxygen therapy

People with this infection have difficulty breathing. So, supplemental oxygen is given to them to maintain adequate oxygen levels. Once oxygen levels are increased, the immune system will be able to better fight infection. Face mask, mechanical ventilation and nasal cannula are some of the ways this therapy can be administered.

3. Hydration and nutrition

Fluids and protein-rich foods are necessary for recovery. “Water, clear soups, and herbal teas can help keep older people with pneumonia well hydrated,” says Dr. Bajaj. Chicken, eggs and legumes are good options to support muscle recovery and immune function. If they have difficulty swallowing, give them soft foods like oatmeal, yogurt, or mashed potatoes.

“Regular assessment of complications such as sepsis (a disease in which the body has a severe inflammatory response to germs, including bacteria) or respiratory failure is also necessary,” explains the expert.

How to prevent pneumonia in the elderly?

Prevention strategies include:

• Pneumococcal vaccine: This vaccine is recommended for adults aged over 65, infants and people at higher risk of pneumococcal infections which can lead to respiratory infections like pneumonia, according to the United Kingdom. National Health Service.
• Flu vaccine: Annual flu shots can reduce the risk of pneumonia.
• Stop smoking: Quitting smoking can reduce the risk of respiratory infections.
• Thick liquids: For those who have swallowing problems, drinking thickened liquids can help.

“Maintaining a balanced diet, exercising regularly and following good hygiene practices can boost overall immunity and prevent pneumonia in older people,” says the expert. Pneumonia in the elderly should not be taken lightly as it can become serious. Know the symptoms and be sure to see a doctor if they experience shortness of breath or a racing heart.