Pneumonia in the Elderly: Don’t miss it!
When our oldest son was a baby he developed pneumonia after choking on some food. The kind of pneumonia he had was called aspiration pneumonia. He ran a temperature, coughed alot, and acted sick. My husband had pneumonia when he was in his forties. He had a cough that just wasn’t getting any better and he felt tired all the time. He had mycoplasma pneumonia. Many people think of pneumonia as a real bad cold. There’s coughing, fever, trouble breathing, fatigue. You are getting worse instead of better. In the elderly, however, the signs and symptoms of pneumonia are much less obvious. Since pnemonia is one of the leading causes of death in the elderly, it is imperative that we know what to look for in this population so that pneumonia can be diagnosed and treated early.
What did I miss?
Over the past year three elderly patients of mine were hospitalized for pneumonia. I saw each of these patients within three days of their hospitalization. I took their temperature, listened to their lungs, and checked their vital signs. All of them were over eighty. I had no reason to suspect pneumonia. When word of their hospitalization came, I was shocked. Self-doubt made me question the nurse assessment I did. I reviewed my notes. One patient with dementia seemed a little more confused than usual. Another patient had a lower than normal temperature. That was it. No cough. No fever. No shortness of breath.
This is what we know about pneumonia in the elderly:
- only half of the elderly run a fever
- respiratory symptoms (cough, sputum production, difficulty breathing) are usually absent
- sudden onset of mental status changes such as confusion can signal pneumonia
- a rapid heart rate or rapid respiratory rate can be the only signs you’ll see
- lung sounds don’t always reveal an abnormality
- a chest x-ray doesn’t always show pneumonia. Dehydration can obsure a pneumonia on x-ray
Early pneumonia is a diagnostic challenge:
Old age and chronic illness puts seniors at risk for pneumonia. Alot of our elderly are malnourished or have had a recent worsening of their general health. More risk factors. Pneumonia should be suspected if a person starts running a fast pulse and maybe acts a little disoriented or maybe the patient is breathing a little fast and his family notices he hasn’t been eating or drinking much recently. Think pneumonia. My patient was acting a bit more confused than usual. That was a red flag. She actually was admitted to the hospital because she fell and broke her arm. The pneumonia was coincidently found on xray.
Words of advice to caregivers:
- keep a thermometer in the house. Take a temperature in the morning and in the evening.
- make sure your elders have a pneumonia shot
- know how to take a pulse (normal:60-100)
- watch for changes in mental status
- seek medical attention early
- keep your loved one hydrated
Tags: caregiving, elderly, pneumonia, pneumonia immunization
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September 17, 2008 at 3:48 am
appreciated this post as I have found that my son, who has severe cerebral palsy, can also have pneumonia with just a low fever or no fever. No cough . Have learned to watch for the no appetite and take his pulse. Anne onegirlfriday@blogspot.com
September 18, 2008 at 1:29 am
Your son is very fortunate to have a mother who is so in tune with the nuances of disease.