Pneumonia is called an old man’s friend because it is often the case that the patient will drift into a state of reduced consciousness, slipping peacefully away in their sleep and providing a dignified end to life.
Pneumonia is common in the elderly. In an article written by Dr B Tipping (1), the estimated rates of hospitalisation for a primary diagnosis of influenza or pneumonia per 100 000 person years were:
- 6.8 in the age group 5 to 49 years
- 219.5 in the age group 75 to 79 years
- Over 600 in the age group 85 years and older
It is important to recognise the context within which pneumonia occurs, because the management differs between each one. The most important contexts are:
- Community-acquired pneumonia (CAP) in fit elderly persons can be managed according to standard guidelines.
- CAP in persons with additional diseases or poor nutrition often produces a mortality up to 30 percent.
- Aspiration pneumonia occurs in frail institutionalised persons and is associated with stroke or vascular dementia.
- Nursing home-acquired pneumonia also occurs in institutionalised elderly persons, making preventative strategies particularly important.
What are the symptoms of pneumonia?
- Coughing, fever and difficulty in breathing may be present in most cases.
- Falls, confusion, new or worsening incontinence, or deteriorating ability to carry out daily activities.
- Respiratory rate > 30 breaths per minute, heart rate > 90 beats per minute, blood pressure < 90 mmHg, temperature < 36.5˚C or > 38.1˚C
When some of these symptoms are present, ensure that the patient is admitted to hospital as soon as possible. It is not easy to identify pneumonia in the elderly, because they may not suffer classic symptoms like fever, chills and cough, so look out for weakness, confusion, dizziness or delirium. Since pneumonia can originate from bacteria or viruses, washing hands regularly will help to prevent the spread. Help your loved one by screening them from visiting others who are ill with colds, flu or respiratory infections. Give encouragement for them to be vaccinated against pneumonia and keep themselves in good general health.
- Pneumonia in the elderly – diagnosis and treatment in general practice Tipping B, MBChB, FCP(SA) Senior Registrar, Division of Geriatric Medicine, University of Cape Town De Villiers L MBChB, FCP(SA) Specialist, Division of Geriatric Medicine, University of Cape Town