Pneumonia in the Elderly: Don’t miss it!

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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:

  1. keep a thermometer in the house. Take a temperature in the morning and in the evening.
  2. make sure your elders have a pneumonia shot
  3. know how to take a pulse (normal:60-100)
  4. watch for changes in mental status
  5. seek medical attention early
  6. keep your loved one hydrated


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8 Comments on “Pneumonia in the Elderly: Don’t miss it!”

  1. onegirlfriday Says:

    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

  2. cwall34 Says:

    Your son is very fortunate to have a mother who is so in tune with the nuances of disease.

  3. Brandon Says:

    Thanks very much for this information — finally, succinctly, specifically in one place, a nice summary of how the presentation of pneumonia in the elderly differs from that in (generally) younger populations. I appreciate and admire the presence of nurses who care, and educate us on such matters. May God bless and guide your work.

  4. nazia asad Says:

    i had a patient 77 years old with pneumonia,confusion was more common than fever, this article is helping me a lot in caring for pneumonia patients next time ,GOD bless you.

  5. Joyce Garland Says:

    I am 69 yrs old and was dx with pneumonia around Christmas. Have been treated with IV antibiotics and oral antibiotics. I am shocked at how long it is taking me to recover. I still do some prn nursing and have not been able to work. But 3 days ago I felt better and worked 2 days. Today I have been in bed and sleeping all day. My deep unproductive cough is back and the difficulty breathing. I have heard that it can take almost a year to get over it when you are older and the immune system is comprimised. Is this true..I have never had this before.

  6. Carol Weaver Says:

    Great info. I was finally able to convince my 90-year-old mother-in-law’s home healthcare worker to take her to emergency this morning. From the flu to a cold then a loss of over 12 pounds in a week in a half. Not eating much. Very weak. Horrible cough. Stage 3 Congestive Heart Failure.
    Stuck in snow a couple hours away waiting for results.

    Great, great info!!!!!!!!!!!!

    • Carol Weaver Says:

      Actually, the healthcare worker tried to get her to go to the cardiologist yesterday, but she refused insisting she was too weak. This morning, she was able to change her mind. So scary when the elderly refuse to get help when they most need it. Based on my little experience, some are afraid to die in the hospital.

      I hope all this information goes to all medical personnel and nursing/medical schools.

  7. B. Toro Says:

    If an elderly patient has a change in mental status due to pneumonia it is most likely secondary to hypoxia so the pulse oxymetry should register a low oxygen level. If every other sign is normal, i.e. cxr, no fever, no white count (high or low) no cough, no shortness of breath, no tachycardia, you would be hard pressed to diagnose pneumonia.

    I have seen people diagnose “clinical pneumonia” when everything else is normal. This is highly suspect.

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