Pneumonia can quickly become a life-threatening condition in the elderly. If you are a Consumer Directed Personal Assistance Program (CDPAP) operating through the Medicaid program, it’s important to understand the signs of pneumonia and what you can do to help a sick person get better more quickly.


Below, we discuss what the disease entails, how it’s treated, and what patients need from their doctors and caregivers.


What is pneumonia?

Pneumonia is a serious respiratory infection of the lungs. It causes inflammation of the air sacs in the lungs, called alveoli. Alveoli normally fill with air when we breathe, but in a pneumonia patient, they get filled with pus or other liquid, making it hard to breathe and limiting oxygen intake.


Can pneumonia affect both lungs?

Pneumonia can affect the air sacs in one or both lungs. It can even affect just part of one lung. When a person has pneumonia in both lungs, it’s often referred to as bilateral pneumonia or “double pneumonia.” This can make it particularly difficult to breathe and requires a doctor’s intervention as early as possible.


A sick person will not be able to tell on their own whether they have pneumonia in one or both lungs. That’s why it’s important to see a doctor as soon as symptoms arise.


What are the symptoms of pneumonia?

Because pneumonia often occurs when a person already has a respiratory infection, it’s hard to tell when sickness has progressed to the point of pneumonia.


However, any trouble breathing should be a sign to contact a doctor.


Signs and symptoms of pneumonia may include:

·         High fever or sweating (or, in rare cases, a lower-than-normal body temperature)

·         Chills or shaking

·         A productive cough (meaning a cough that  produces phlegm)

·         Shortness of breath

·         Chest pain when breathing or coughing

·         Fatigue or feeling sapped of energy

·         Feeling very sick shortly after recovering from a cold or flu

·         Nausea, vomiting, or diarrhea during a respiratory infection

·         Urinary incontinence (typically in seniors)

·         A lack an appetite

·         Confusion or delirium


How serious is pneumonia in older adults?

Adults 65 and older are more susceptible to pneumonia than younger people because their immune systems may not be as capable of fighting off infection. It is also more likely to have severe consequences, lead to hospitalization, and even be fatal in seniors.


Most of the people who die from pneumonia each year are elderly adults, according to the American Lung Association (ALA). The death rate among elderly adults with severe pneumonia is as high as 30%. Pneumonia is also the second leading cause of hospitalization of Medicare beneficiaries.


Even after the elderly are discharged from the hospital, pneumonia can still be fatal. Of the deaths that occur in the elderly from pneumonia, 47.6% occur after discharge from the hospital.


What causes pneumonia in elderly adults?

In the U.S., pneumonia in the elderly is usually caused by bacteria or a virus. However, there are multiple ways to contract the infection.


Types of pneumonia

Many people don’t realize that there are over 30 different causes of pneumonia, but they break down into 4 general categories.


·         Bacterial pneumonia – Bacterial pneumonia is most commonly caused by the bacteria called Streptococcus pneumoniae (pneumococcus). However, doctors generally cannot discern which exact germ in particular is affecting the lungs.


Bacterial pneumonia is contagious and occurs when a person breathes in airborne bacteria which then multiplies in the lungs before their immune systems can fight it off.


·         Viral pneumonia – Viral pneumonia operates much like bacterial pneumonia, but it is most commonly caused by the cold or flu virus. It often occurs when someone already has a bacterial infection that has weakened their immune system.


Viral pneumonia can be harder to treat, so it’s important that elderly patients are monitored for symptoms if they are already ill.


·         Fungal pneumonia – Fungal pneumonia is most common in people with severely weakened immune systems and is unlikely to be contagious. Immunocompromised people such as transplant recipients, those undergoing chemotherapy, or people with HIV have a higher chance of developing pneumonia after breathing in fungal spores.


Those who work with the soil (such as farmers, landscapers, or construction workers) are more likely to come into contact with fungal spores, but the strength of your immune system is still the most important predictor of whether or not the inhalation of these spores will lead to pneumonia.


·         Aspiration pneumonia – Aspiration pneumonia is not contagious because it is occurs when you breathe in (or “aspirate”) food, fluid, or vomit into your lungs. Most people have had this happen to them at some point, and it’s rare that it will lead to pneumonia.


However, if a person is unable to easily cough up the material (for example, those who are frail or under the influence of drugs or alcohol) or has poor oral hygiene, bacteria from the aspirated substance or from your mouth can begin to multiply in the lungs and cause pneumonia.


A doctor will need to run tests to determine what kind of pneumonia an elderly patient has.


Testing for pneumonia

First, a doctor will take a patient’s health history and perform a physical examination (which includes listening to a patient’s lungs) to determine if pneumonia is likely. They may order more diagnostic tests to confirm a pneumonia diagnosis and try to determine which organism is causing the infection so they can prescribe the proper treatment.


The following tests may be performed by doctors if they suspect a patient has pneumonia:

·         Blood tests (to confirm there is an infection and try to identify the cause

·         Chest X-ray (to locate the site of the infection and assess the amount of inflammation in the lungs

·         Pulse oximetry (to measure the levels of oxygen in the blood)

·         Sputum test (to test a sample of fluid from the lungs)

·         CT scan (to get a good look at the extent of the pneumonia and the damage it has done to the lungs)

·         Pleural fluid culture (which is performed by taking a sample from the pleural area between your ribcage with a needle)


Who is at risk for pneumonia?

Aside from adults over 65, infants and young children, as well as those who have other health issues are at the highest risk of developing pneumonia. It can also be problematic for those who have a weakened immune system, those recovering from surgery, and people with respiratory and viral infections.


While age is a major factor in both pneumonia and its mortality rate, the following are also risk factors:

–          Smoking

–          Exposure to air pollution

–          Lingering respiratory infections

–          Excessive drinking

–         Comorbid conditions such as obesity, diabetes, and chronic respiratory infections


How is pneumonia treated?

When you or an elderly loved one is diagnosed with pneumonia, a doctor will provide a treatment plan. The goals of pneumonia treatment are:

·         To eliminate the bacteria causing the infection

·         To prevent any complications

·         To treat symptoms in order to reduce discomfort


Because there are different kinds and causes of pneumonia, there are different treatments. For example, while a doctor may not be able to tell you exactly what bacteria is causing the condition, they will likely be able to tell you when bacteria is the cause and prescribe antibiotics.


If you are acting as a caregiver to an elderly person with pneumonia, it is important to make sure they adhere to their antibiotic treatment regimen. Helping them take their medication each day at the same time and ensuring they finish the entire prescription are of the utmost importance in order to ensure the infection does not come back. Patients who are ill and fatigued or elderly people with memory or other cognitive issues should have their medication monitored by a caregiver.


However, if the pneumonia is caused by a virus, antibiotics will not help and could even lead to more serious infections down the road that are not easily treatable. In these cases, a doctor may prescribe an anti-viral.


In other cases, doctors may simply prescribe rest and other healthy behavior so the body is strong enough to fight off the infection by itself. But it’s crucial to let a doctor make this decision and not try to treat something as serious as pneumonia without professional advice.


Other treatment options for those with pneumonia include oxygen therapy and oral rehydration therapy.


Complications of pneumonia in elderly adults

Elderly adults can take anywhere from 6 to 8 weeks to recover from pneumonia. This is, in part, because their bodies have a harder time fighting off the illness, leaving them in a weakened state.


It is important to get a proper diagnosis from a doctor and begin treatment as soon as possible to increase an elderly adult’s chances of recovery (or at least the prevention of double pneumonia).


Pneumonia may cause other complications including:

·         Bacteremia

·         Pleurisy

·         Lung abscess

·         Acute respiratory distress syndrome (ARDS)

·         Respiratory failure

·         Lung Abscesses

·         Kidney, Liver & Heart Damage

·         Urinary Tract Infections

·         Sepsis


Seniors who have pre-existing health conditions are more likely to experience complications from pneumonia, so it is important to take the recovery process seriously.


Preventing pneumonia in older adults

Preventing pneumonia altogether is the best way to stay safe. Elderly people and their elderly caregivers should get both the pneumococcal vaccine and a yearly flu shot to try and prevent  bacterial and viral infections.


Like any other infectious disease, the bacterial, viral, and fungal causes of pneumonia can be headed off with good health and hygiene habits. Washing hands, especially after you’ve been in public, is critical. And if you are immunocompromised during cold and flu season, it is wise to wear a mask to protect yourself from airborne infections.


Those at risk should also take care of their health by diligently managing any chronic diseases they have. Maintaining good health is essential and can be achieved through proper rest, exercise, and a healthy diet.


If you are a caregiver to an elderly person, you may also need to take special care in avoiding those who are ill and could possibly pass respiratory infections on to you. It’s easy for caregivers to pass germs to the elderly through close contact and airborne particles.


Seniors should keep their distance from anyone who is ill and exercise caution while traveling or inviting people into their homes. While it can be hard to stay away from family members, such as grandchildren, it’s important to remember that pneumonia can also be dangerous to young children. It’s worth remembering that transmission can go both ways.


If you are a senior or caregiver to a senior who is traveling – no matter the distance – you should take special precautions to protect yourself from breathing in airborne germs. Actions such as wearing a well-fitting, medical-grade facial mask and washing your hands thoroughly can go a long way in preventing infection.


Home hygiene is also an important piece of the puzzle. If an elderly person’s living accommodations are unsanitary and contain mold, mold, or mildew, it can contribute to respiratory infections and pneumonia. It’s important to keep homes clean and dry and for caregivers to monitor a client’s living conditions.


Caring for seniors with pneumonia

If your loved one has been diagnosed with pneumonia, there are ways you can give them a better chance at regaining their health. Elderly people in particular will need a managed environment that’s kept safe from stressors and anything that might make their condition worse


Here are some of the things CDPAP caregivers will need to do if a loved one has pneumonia:


–          Monitor symptoms closely

Regardless of whether a patient is at home or temporarily in a healthcare facility, if you are the one who sees them the most often, you will usually be the first to notice any change in their symptoms. Monitor coughs and breathing closely in case a doctor needs to be alerted.

–          Provide transportation to medical appointments and prescription pick ups

Those suffering from pneumonia, particularly the elderly, should not operate a motor vehicle on their own.

–          Assist with household chores

Many caregivers do this anyway, but it’s particularly important to deep clean the homes of elderly pneumonia patients to be sure bacteria and viruses are killed and fungus doesn’t make it way into the house. Houses should also be rid of all cigarette smoke and other air pollutants that can compromise breathing.

–          Administer medication

It will often be up to a caregiver to set a medication schedule and make sure a patient sticks to it. This is very important in the event a patient is given antibiotics.

–          Manage mealtime

Pneumonia patients find it hard to breath and swallow and so they often experience a loss of appetite. However, without calories, the body cannot mount a defense against disease, so healthy meals should be prepared to keep elderly patients nourished. It’s also critical to keep them hydrated.

–          Manage oral hygiene

The role of caregiver often extends to matters of hygiene. It may be necessary to remind or help your loved one with brushing and flossing so they can avoid the growth of bacteria in their mouths that cause infections.


Pneumonia is a common infection in the elderly, so caregivers should be prepared to monitor them closely and ensure that extra precautions are in place to prevent serious illness.