Pneumonia in the Elderly
Pneumonia in the elderly is a massive topic. Did you know that there are over 30 different causes of pneumonia and that there are different types of pneumonia? In this article, we tackle some of the bigger questions people might have about pneumonia and the elderly.
We also focus on community-acquired pneumonia, which is a type of pneumonia that occurs in large populations of elderly people, such as in a hospital, an assisted living facility, or even in an apartment complex.
What is the Recovery Time for Pneumonia in the Elderly?
A simple Google search for that question makes us think that an elderly person can recover from pneumonia in in as little as two weeks but it may take two months or longer to recover completely.
A study that appeared in the Patient Related Outcome Measures Journal shed some light on the vast difference between a short recovery and a long one.
They begin by understanding the health status of the elderly person who is afflicted with pneumonia. For those that are in good health, expect a recovery time of about three weeks. In that period, shortness of breath, weakness, and fatigue are common. If the elderly person has existing health conditions, especially those that involve the respiratory system, such as COPD the recovery period can take as long as 60 or more days and be far more challenging. 
What are the Signs and Symptoms of Pneumonia in the Elderly?
As with many diseases and illnesses, the signs and symptoms vary from one person to the next and may mimic other disorders too. In general terms, the following are common signs and symptoms of pneumonia in the elderly. 
- Confusion – In elderly people, pneumonia can cause confusion or disorientation. They may complain about having a hard time thinking or seem addled when trying to explain or do things that are normally not challenging for them. This type of symptom mimics other diseases such as dementia and can be a result of medications so it is hard to diagnose pneumonia based on this symptom. However, any change in mental status should be reported to a doctor or in a facility, to a medical professional, such as the charge nurse.
- A Productive Cough – Typically, moist and wet sounding coughs that produce phlegm. You may also hear audible wheezing as the person inhales and exhales. These symptoms also mimic the common cold and the flu. The general rule of thumb is that a cold with a fever should be evaluated, especially for the elderly.
- Fever – There are various types of pneumonia and some may only produce a low-grade fever in the 99°F – 100°F range while others may produce fevers above 101°F. Fevers often include sweating and shaking, both of which is the body's natural response to being overheated. A fever that lasts more than 24 hours should be evaluated.
- Chest Pain and Rib Pain – Pneumonia can be painful on a couple of levels. First, there is often rib pain because of the chronic coughing. In the elderly, heavy coughing can fracture ribs and potentially cause spinal problems, such as slipped disk and vertebra alignment issues. In addition, the added fluid in the lungs means that people either have to pant or take deep breaths and breathing deeply can be painful.Rapid breathing or panting is a serious symptom and should be evaluated immediately. Generally, it means that the surface area of the lungs are covered and the remaining lung tissue must do more work to supply vital organs with oxygen. This often coincides with pale and clammy skin. Panting is a sign of many life-threatening illnesses such as heart attack, congestive heart failure, and shock. These symptoms should always be evaluated immediately.
- Fatigue – Pneumonia is a draining illness that saps elderly people leaving them exhausted. That tiredness comes from many aspects of the illness. First, it takes a lot of energy for a body to fight off an illness. it can also increase the risk of falls and secondary injuries.
- Fever, which is heat, burns a lot of energy just like a furnace. The higher the heat setting the more fuel it burns. There is a lot of physical labor with pneumonia too. Coughing, rapid breathing, and the struggle to do anything all take up a vast amount of energy. That energy drain can rob the immune system of the energy it needs to do its job.The lack of oxygen also contributes to fatigue. As the body shuttles oxygen to the most important organs it leaves the muscles starved and weak. This weakened state puts elderly people at risk for compound injuries, such as falling, broken hips, and sprains.
As mentioned, the symptoms of pneumonia vary from one person to the next and change based on the health level of the person who is inflicted. Those with chronic disease have the hardest time, but pneumonia can be deadly even in the healthiest of our elders.
What is the Survival Rate for Elderly that have Pneumonia?
According to the Centers for Disease Control (CDC) around a million people in the United States go to the doctor or an emergency room for treatment of pneumonia. Of those who seek treatment, 50,000 die each year. 
With community-acquired pneumonia (CAP) 10 percent who are admitted are placed in an ICU unit. Even in ICU, the death rate of people with pneumonia can reach 25 percent. 
Survival depends on many factors. Age is an important factor and more elderly people succumb to pneumonia than any other adult group. Overall health is another important factor as those with existing health issues face a harder time fighting off pneumonia.
How is Pneumonia in the Elderly Treated?
For most adults, antibiotics are used to treat pneumonia. For those who are more fragile or who have other health issues, inpatient treatment is required. This can mean being admitted to the ICU, being intubated and placed on a respirator, and having advanced breathing treatments with pneumonia-specific medications. It can also mean all of these treatment options.
Prevention of Pneumonia
They say that “prevention is worth a pound of cure” and when it comes to preventing pneumonia they are right. Vaccines are the primary way that elderly people can improve their odds of not catching pneumonia. Other preventions, include eating a well-balanced diet that is rich in foods that support the immune system. Hand-washing is also important and when available to the use of hand sanitizer can help too. Pneumonia is spread by contact and inhalation. Paying attention to surfaces is important. Coughing into a handkerchief helps keep pneumonia and other germs out of the air.
As a last tip, the Mayo Clinic has a wonderful resource on the Do's and Don'ts of hand-washing. In the meantime, pay close attention to all of those old sayings – An apple a day!