Why You Need to Learn About the Dangers of Elderly Pneumonia

Pneumonia in elderly people is somewhat common, but some forms can be extremely dangerous. Seniors are especially susceptible and can easily contract pneumonia in nursing home settings. There are a few different types of pneumonia as well as different sets of symptoms. Often, the elderly display pneumonia symptoms differently than those who are younger.

Various measures can prevent pneumonia. Treatment methods will vary depending on the severity and type of illness.

By The Numbers

Pneumonia in the elderly occurs more frequently than in other age brackets. As a result, there are more cases of morbidity and mortality. The incidences occur gradually with age, from 1 per 1,000 to 12 per 1,000 persons over the age of 75.

A staggering 85% of pneumonia and influenza deaths occur within the senior citizen age bracket (age 65). Just 3% of these deaths took place in those who were age 45 or younger. Those in the 65+ age bracket accounted for the highest hospitalization rates.

Pneumonia Symptoms In Elderly People

Symptoms of pneumonia in elderly people may differ from that of children or younger adults. The elderly may also display fewer symptoms or non-specific symptoms. Pneumonia in the elderly may include lethargy, confusion, or general deterioration.

Although symptoms can vary in general depending on the severity and the person, they usually include:

  • Coughing; which may include yellow, greenish, or even bloody mucus
  • Fever ranging from mild to high
  • Chills
  • Shortness of breath or difficulty breathing
  • Sharp or stabbing pain upon taking deep breaths or coughing
  • Headache
  • Excessively sweating or having clammy skin
  • Confusion or lethargy

Whether the type of pneumonia is bacterial or viral will also account for the symptoms displayed.

Bacterial Pneumonia Symptoms

In bacterial pneumonia cases, a person may see their temperature escalate as high as 105 degrees. Confusion and delirium are two signs of a patient suffering from bacterial pneumonia. They also may have bluish-colored lips or nailbeds as a result of the lack of oxygen in the blood. Other indications of bacterial pneumonia include:

  • Rapid breathing
  • Increased pulse
  • Profuse sweating

Viral Pneumonia Symptoms

When suffering from viral pneumonia, the symptoms closely mirror that of influenza. Symptoms such as a dry cough, headache, fever, muscle pain, and weakness may appear. Within a 12 to 36-hour time frame, the coughing may become worse and produce mucus. Those suffering may also notice an increase in breathlessness. High fever and blueness of the lips are also common symptoms of viral pneumonia.

Mycoplasma pneumonia is a less common form. Mycoplasma pneumonia is sometimes referred to as “atypical pneumonia.” The bacteria type differs between that of Mycoplasma pneumonia and other forms. Although this kind of pneumonia more commonly affects younger people, it is still possible for seniors to contract it. The most common symptoms are chest pain, chills, cough, sweating, and fever.

What Causes Pneumonia?

Pneumonia in the elderly occurs in many ways. In most cases, it’s hard to identify the specific bacteria or virus even after testing. Streptococcus tends to be the most common bacteria identified in pneumonia cases. However, many types of a bacterium can lead to pneumonia.

In impaired immune systems, other organisms are capable of causing pneumonia. Some of these organisms include particular fungi. Those who are recovering from surgery are at heightened risk for contracting pneumonia. Respiratory disease, viral infections, or weakened immune systems increase risk as well.

Malnourishment or weaker immune systems are common in many seniors. These seniors are more susceptible to the multiplication of pneumonia bacteria working their way into the lungs. The infection may then spread rapidly through the bloodstream and travel throughout the body.

Risk Factors

Elderly nursing home residents are particularly susceptible to pneumonia. Pneumonia is the second leading type of infection within these homes.

Many studies have aimed to identify specific pneumonia risk factors in nursing homes. These risk factors include:

  • Poor functional status
  • Presence of a nasogastric tube
  • Dysphagia
  • Increasing age
  • Presence of a tracheostomy

Chronic obstructive lung diseases were also found to be common risk factors. Alcoholism and heart disease also identified as significant risk factors.

Hospital-acquired Pneumonia

Hospital-acquired pneumonia can be severe or even fatal. Pneumonia of this variety occurs in hospital settings and tends to be more severe. Those who are in hospitals are usually very sick and unable to fight off germs. The germ variants within hospital settings are often more dangerous and more resistant to treatment.

Pneumonia can spread in hospitals through workers who may pass the germs from one person to another. Those who are more likely to contract pneumonia in a hospital include those with:

  • A history of alcohol abuse
  • Compromised immune system from cancer treatment, medications, or wounds
  • Swallowing issues and breathe either food or saliva into their lungs
  • Chronic lung disease

One of the first signs of hospital-acquired pneumonia in elderly patients is confusion or mental changes. Other signs may include general pneumonia symptoms such as:

  • Coughing
  • Chills
  • Fever
  • Nausea
  • Shortness of breath
  • Chest pain
  • General discomfort

Diagnosis And Testing

Diagnosing pneumonia works in a few different ways. The most standard means of diagnosing pneumonia is through a physical exam. Using a stethoscope, a physician will listen to the lungs of the patient as they breathe. If the lungs make crackling or bubbling sounds, pneumonia is likely present. There may also be wheezing, and breathing sounds in some areas may be difficult to hear.

A chest x-ray is another method used to diagnose pneumonia. Sometimes additional tests are necessary depending on the patient. Some of these tests include:

  • A blood test to determine white blood cell count as well as whether the germ is present in the blood
  • Arterial blood gasses which reveal whether enough oxygen is getting into the bloodstream through the lungs
  • A CAT scan for a better view of the lungs
  • Bronchoscopy, which looks into the airways of the lungs. Doctors perform a bronchoscopy when hospitalization is necessary, and antibiotics are not helping
  • Pleural fluid culture if there is fluid around the lungs

Treatment / Medications

Several factors will determine how to treat pneumonia in elderly patients. Some of these factors include the type of pneumonia, the severity, and the germ that is causing the infection. Those who contract pneumonia in a community-based setting, which is the most common, are usually treated at home.

Bacterial Pneumonia

The standard course of action for treating bacterial pneumonia is a prescription of antibiotics. It is possible that symptoms will start to dissipate before the prescription runs out. It is important to continue taking the medication anyway. Patients who halt their antibiotic use early may be at risk for pneumonia returning.

Antibiotics will usually reduce bacterial pneumonia symptoms within 1-3 days.

Viral Pneumonia

When it comes to viral pneumonia in elderly people, antibiotics are not a treatment option because they will not be effective against the virus. Antiviral medicines are the most common treatment option for this type of pneumonia. Viral pneumonia should, in most cases, improve within 1-3 weeks on medication.

Severe Symptoms

Hospitalization may be necessary when symptoms become more severe. Hospitalization may also be required if the patient is not responding to antibiotics. Other health issues sometimes put a patient at higher risk for complication.


Many options can reduce the risk of contracting pneumonia. Because the flu is such a common cause of pneumonia, getting vaccinated and preventing the flu will also prevent pneumonia.

Seniors should also get a pneumococcal pneumonia vaccine, which is a common form of bacterial pneumonia. Other vaccines are available that combat against the bacteria and viruses that can lead to elderly pneumonia as well.

Although it should be a standard practice, washing hands frequently is necessary. Especially after using the bathroom, using tissues, and before eating or preparing meals. Bacteria can transfer easily from the hands.

Smoking cigarettes are also strongly discouraged. Smokers are at higher risk for developing pneumonia. Smoking cigarettes impair our lung’s ability to fight infection.

Having good health practices and habits can also lower the risk of developing pneumonia.

Seniors must exercise special care and attentiveness to pneumonia. Especially in assisted living or hospital settings. These settings put residents at increased risk. Without proper treatment, pneumonia can be life-threatening. Have you or someone you love dealt with a case of pneumonia? We encourage you to share with us your experience as well as how you got well in the section below!

Sean Byers, MD

Sean Byers, MD

Sean Byers is currently a Resident in the Internal Medicine program at UTMB. He studied at the University of Queensland School of Medicine as well as received his Master’s in Public Health with a focus in epidemiology and biostatistics at the University of Southern California. His background is in biology, computer science, public health, and internal medicine.

Recommended Articles


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