Pneumonia in Older Adults

Pneumonia is an infection of one or both lungs caused by bacteria, viruses, or fungi. Every year, more than 1 million adults in the United States go to the hospital to receive care for pneumonia, and 50,000 people die from it.

Older adults are often at higher risk for pneumonia, and the infection may be more severe than it would be for younger people.

This article discusses pneumonia in older adults, including prevention, symptoms, causes, diagnosis, and treatment.

Symptoms of Pneumonia in Older Adults

Despite a serious case of pneumonia, older people—especially those with a weak immune system or other illnesses—may have milder symptoms.

Older people may not have a fever with pneumonia. Their body temperature is sometimes lower than normal when they are sick. Changes in alertness or mental ability (new or worse confusion) can be a sign of illness or infection in older people.

Classic Symptoms of Pneumonia

Common symptoms of pneumonia may include:

• Cough
• Mucus (may change from clear to yellow, green, or have blood in it)
• Fever
• Sweating or chills
• Shortness of breath
• Fast, shallow breathing
• Chest pain (may worsen with a deep breath or cough)
• Loss of appetite
• Fatigue
• Nausea and vomiting (more likely in children)
• Confusion (more likely in older adults)
  

What Causes Pneumonia in the Older Population?

Bacteria, viruses, and fungi cause different types of pneumonia. Aspiration pneumonia is typically caused when food, liquids, or other substances are accidentally introduced into the lungs and cause infection and inflammation.

You can be exposed to the germs that cause pneumonia in your surroundings, or another person can spread the germ that causes a pneumonia infection.

Community-Acquired Pneumonia (CAP)

Community-acquired pneumonia (CAP) is any pneumonia acquired outside of a hospital. CAP is estimated to cause over 1 million hospital admissions each year. People older than 65 are far more likely to develop CAP than younger people.

Healthcare-Associated Pneumonia (HCAP)

Healthcare-associated pneumonia (HCAP) is developed during or after a stay in a healthcare facility (hospitals, skilled nursing facilities, etc.). HCAP is typically any pneumonia that occurs 48 hours or more after hospital admission. It is one of the most common healthcare-acquired infections.

Aspiration Pneumonia

Aspiration pneumonia occurs when foreign material, such as food, "goes down the wrong pipe" and ends up in the lung. Any substance can be aspirated, but common types include:

• Food
• Saliva
• Bacteria
• Drinks (and other liquids)
• Stomach contents
  

What Germs Cause Pneumonia?

Pneumonia is an infection most often caused by a germ. The most common bacteria in pneumonia infections is Streptococcus pneumoniae (pneumococcus).

Respiratory viruses can also cause pneumonia, including influenza (flu); SARS-CoV-2, which causes COVID-19; and rhinoviruses, which cause the common cold.

Diagnosis of Pneumonia in Older People

Older adults may have atypical pneumonia symptoms. Fevers may be less common, and older people may appear confused when they have an infection. Your healthcare provider may use a combination of tests to help determine if you have pneumonia, including:

• Vital signs (checking for fever, increased heart rate, increased breathing rate)
• Physical examination
• Auscultation (listening to your breathing through a stethoscope)
• Chest X-ray
• Chest CT (computed tomography) scan
• Sputum culture (phlegm secreted from cells in your lower airways)
• Blood tests

When to See a Healthcare Provider

It is recommended that people 65 years and older see their healthcare provider for symptoms that might be pneumonia. Contact your healthcare provider if:

• You have a worse or severe cough.
• Your fever continues.
• You have trouble breathing.
• You cannot take your medicine.
• You have started antibiotics and do not feel better after three days.

Treatment of Pneumonia in Older People

Pneumonia treatment depends on many factors. Be sure you understand what treatments are recommended for you and why you should complete them.

Medications

Antibiotics, antivirals, and antifungals are used depending on what kind of pneumonia you're dealing with. Some antibiotics can be taken at home as oral pills. However, sometimes stronger intravenous (IV) antibiotics are required, and you may need to be admitted to a hospital. Your provider will discuss your options with you.

Oxygen Therapy

Pneumonia can cause inflammation and increased lung mucus, making it hard for oxygen to enter the blood. If your oxygen levels are low, you may be provided oxygen therapy.

Fluids

Extra fluids may provide benefits such as thinning mucus and helping replace fluids lost through extra breathing or fevers. Despite this general approach, only a few trials have studied fluid intake for people with pneumonia.

Rest

Coughing, getting lower levels of oxygen, and being sick can cause tiredness or fatigue when you have pneumonia. Some people also find it hard to sleep with a respiratory illness.

Allow extra time for rest and sleep. Follow any directions from your provider about cutting down your activity level, taking time off from exercise, or otherwise adapting your physical stress.

Heat and Humidity

Warm steam, as created with a bath, a shower, or a humidifier, can help with pneumonia symptoms by relaxing airways, making it easier to breathe. Warm, humid air can help loosen phlegm that helps you cough it up. Warm beverages like broth or tea can have a similar benefit for some people.

OTC Medications

Over-the-counter (OTC) medications may help with some mild pneumonia symptoms. Check with your medical provider before using any cough medications. Coughing is an important way for the body to clear out the germs causing pneumonia and the mucus that develops.

Recovery from Pneumonia in Older Adults

Recovery from pneumonia varies from person to person. This is especially true for older adults who tend to have more complications from pneumonia, including decreased physical function.

Complications

About 20% of people with pneumonia will need to be hospitalized. For some people, pneumonia infection can lead to scars and permanent lung damage, even with treatment.

Complications of pneumonia can also include:

• Respiratory failure: When your lungs cannot move oxygen in and carbon dioxide out
• Acute respiratory distress syndrome (ARDS): A severe form of respiratory failure
• Lung abscess: Pus-filled cavity in the lungs caused by an infection
  
• Sepsis: Potentially life-threatening infection that moves through the bloodstream
  

How to Prevent Pneumonia in Older Adults

Pneumonia vaccines have been shown to reduce the risk of pneumonia, especially for bacterial varieties. There are different vaccines available. Speak with your healthcare provider about which one or combination may be right for you.

Handwashing is key to reducing your risk of pneumonia. Quitting smoking and making healthy lifestyle choices may also help prevent it.

Summary

Pneumonia is a respiratory infection that ranges from mild to severe. Older people may have more significant illnesses and longer-lasting effects than younger people. Treatments for pneumonia are often effective and can include medications, oxygen therapy, fluids, and rest. See your healthcare provider right away if you have pneumonia symptoms.

A Word From Verywell

Pneumonia can be a scary diagnosis, especially for an older person. Pneumonia vaccines help reduce your risk of getting sick. Good hand-washing habits and avoiding ill people may also help you stay healthy. Talk with your healthcare provider about ways to prevent pneumonia, especially as you get older.