Pneumonia in the elderly is quite common. This pathology is especially prone to bedridden and debilitated patients, as well as patients with chronic diseases. In old age, pneumonia often occurs with atypical symptoms. Because of this, diagnosis and treatment are often delayed, and advanced pneumonia can lead to serious complications. In the article we will consider in detail the causes and characteristics of the symptoms of pneumonia in old age, as well as methods of treating this pathology.
Age-related changes in the respiratory system
A provoking factor in the development of pneumonia in the elderly and old people is age-related changes in the lung tissue. During this period of life, the human respiratory system is characterized by the following features:
- The walls of the pulmonary vesicles (alveoli) become thinner and less elastic.
- There is atrophy of the mucosa of the bronchi and trachea.
- The ventilation capacity of the lungs is deteriorating.
- Too deep a breath and delayed expiration are often noted. This is due to the fact that the lungs of an elderly person take an excessively large amount of air.
- Cartilage of the bronchi and trachea undergo dystrophy.
These age-related changes lead to a violation of gas exchange, oxygen starvation of tissues and an increase in the concentration of carbon dioxide in the blood.
Provocative factors
There are various adverse factors that increase the risk of pneumonia in elderly patients. These include:
- Low mobility. Very often pneumonia occurs in bedridden elderly people. The lack of movement leads to stagnation of blood, and then to the expansion of the pulmonary vessels. Enlarged capillaries press on the pulmonary vesicles. Squeezed tissue is very susceptible to infection and is easily inflamed.
- Diseases of the internal organs. In old age, cardiovascular pathologies, diabetes mellitus, as well as kidney diseases, are often noted. All these ailments can trigger inflammation of the lung tissue.
- Frequent hospital stay. In old age, various chronic pathologies are often exacerbated, and old people have to go to the hospital. Doctors distinguish a nosocomial (hospital) form of pneumonia. This pathology can occur several days after the patient is placed in a hospital. This type of pneumonia occurs in patients after bronchoscopy, as well as after surgical interventions. Patients on mechanical ventilation also have an increased risk of pneumonia.
- Smoking. As already mentioned, in older people, lung tissue undergoes age-related changes. Therefore, the effects of nicotine on the respiratory system becomes especially dangerous.
- Uncontrolled intake of antibiotics. Often, older people with infectious diseases use an excessive amount of antibacterial drugs. This can provoke a decrease in immunity.
Inflammation of the lungs is much more difficult if the patient has a history of more than two of the above factors. In this case, the prognosis of pneumonia in the elderly is significantly worse.
General symptoms and types of pathology
Signs of the disease depend on the size and location of the lesion. However, common symptoms of pneumonia in the elderly can be distinguished:
- cough (dry or wet);
- difficulty breathing
- blue fingers;
- temperature rise;
- heaviness and pain in the chest.
However, in old age the usual clinical picture of pneumonia is far from always noted. This disease is very often atypical. The older the patient, the more difficult it is to diagnose pneumonia.
The disease can begin with neurological manifestations due to respiratory failure and hypoxia. In this case, an elderly person has signs of cerebral ischemia and mental abnormalities. Often, pneumonia in the elderly is accompanied by pain in the heart or dyspeptic symptoms. In addition, many other chronic pathologies are exacerbated during pneumonia in the elderly.
Pneumonia in the elderly is often accompanied by extrapulmonary manifestations:
- apathy;
- drowsiness
- urinary incontinence;
- disorders of consciousness;
- leg pain due to venous stasis;
- arrhythmia.
As already mentioned, the symptoms of the disease largely depend on the type of inflammatory process. In medicine, the following forms of pneumonia are distinguished:
- one-sided focal;
- croupous;
- bilateral;
- stagnant;
- interstitial.
Next, we will consider in detail the symptoms and features of pneumonia in the elderly, depending on the type of pathology.
Focal form
Unilateral focal pneumonia often occurs in patients suffering from diseases of the heart and blood vessels, accompanied by ischemia. In this disease, the pathological process affects a separate segment of the lung tissue. Pathology is accompanied by fever and tachycardia. Elderly patients are very difficult to tolerate the disease.
Pneumonia in the elderly over 85 years often occurs in large focal form. In this case, a large segment of the respiratory organ is affected. A decrease in the volume of the chest from the inflamed lung is noted. Such a pathology is accompanied by rapid and difficult breathing, as well as a feeling of lack of air.
Croupous form
With croupous pneumonia, an entire segment of the lung becomes inflamed. Often, the pathological process goes to the pleural region. This type of pneumonia in old age is quite rare.
Croupous pneumonia in the elderly is often atypical. In young patients, this disease always begins with severe fever and a sharp deterioration in well-being. In patients of senile age, the temperature is usually moderately elevated, and a blood test shows only a small leukocytosis. The disease often proceeds in an erased form. Often, croupous pneumonia begins with a pain in the heart, similar to an attack of angina pectoris. This greatly complicates the diagnosis.
Elderly patients complain of a dry cough. In this case, sputum leaves them with difficulty. Such an erased clinical picture of the disease is a great danger. Old people develop heart and respiratory failure very quickly against the background of croupous pneumonia. Such complications are accompanied by a serious deterioration:
- severe shortness of breath;
- blue skin;
- loss of consciousness.
Due to oxygen deficiency, hypoxia of the brain develops, which leads to irreversible neurological changes. In the presence of complications, croupous pneumonia in old age ends fatally in 30-40% of cases.
Bilateral pneumonia
With this pathology, inflammation in both lungs is diagnosed. It can be focal, in this case only part of the tissue is affected. There is also total bilateral pneumonia, in which the inflammatory process affects the entire lung tissue.
Bilateral pneumonia in an elderly person often occurs against the background of mechanical ventilation. Most often, the pathology proceeds in a focal form. In this case, the following symptoms are noted:
- temperature increase (up to +40 degrees);
- difficulty breathing
- cyanosis of the skin;
- chest pain
- cough worse with movement.
The disease has an unfavorable prognosis, since inflammation usually affects large segments of the lungs.
Total inflammation is quite rare. This type of disease is accompanied by severe shortness of breath. Due to brain hypoxia, neurological disorders occur: confusion, drowsiness, or excessive agitation.
Stagnant pneumonia
This kind of pathology is found in bedridden patients. The cause of the disease is circulatory disorders and the attachment of a bacterial infection. Congestive pneumonia in the elderly is often masked as signs of a underlying pathology. For example, in bedridden patients with a stroke, neurological symptoms may occur at the onset of the disease. Also, in patients with femoral neck fractures, the initial manifestations of pneumonia can be bone pain. Therefore, it is rather difficult to detect congestive pneumonia at an early stage.
The classic signs of pneumonia in an elderly person often appear only in the late stage of the disease. This is expressed in the occurrence of the following symptoms:
- a slight increase in temperature (up to +38 degrees);
- wet cough;
- sputum discharge with an admixture of pus and blood;
- loss of appetite;
- nausea
Congestive pneumonia is always accompanied by impaired heart function: pain in the sternum, arrhythmia, interruptions. In some cases, in older people, the pathology is atypical. Symptoms of the respiratory system are absent, but dyspeptic symptoms (diarrhea, nausea, vomiting) occur.
A dangerous sign is increased breathing (more than 20 breaths per minute) and a feeling of suffocation. Such symptoms indicate damage to a large area of lung tissue. Due to hypoxia in patients, dysfunction of the central nervous system occurs. The patient sleeps most of the day, his speech becomes incoherent.
Interstitial form
With this pathology, inflammation of the interstitial lung tissue occurs, accompanied by fibrotic changes. The exact causes of interstitial pneumonia in the elderly have not been elucidated. The disease most often develops in patients with reduced immunity and in smokers.
The interstitial form of pneumonia is accompanied by the following symptoms:
- shortness of breath
- chest pain
- increased sputum production;
- anxiety
- constant hunger;
- increase in temperature to subfebrile digits.
This is one of the most dangerous forms of pneumonia. Fibrous tissue changes are steadily progressing, leading to severe respiratory distress and heart failure. With extensive sclerotic lung lesions, the prognosis of the disease is unfavorable.
Diagnostics
Pneumonia in the elderly is very often atypical, with erased symptoms. This pathology can disguise itself as many other senile diseases. Because of this, the diagnosis of pneumonia is significantly difficult.
The doctor conducts auscultation of the patient. It is very important to differentiate pneumonia from cardiovascular diseases, neurological disorders and tuberculosis. For this purpose, the following examinations are prescribed to patients:
- X-rays of light;
- bronchoscopy;
- clinical blood and urine tests (to detect signs of inflammation);
- a study of sputum for bacterial seeding (with the determination of the sensitivity of the pathogen to antibiotics);
- MRI and CT of the lungs.
The treatment of pneumonia in the elderly is most often carried out in a hospital setting. This disease in old age very often proceeds unfavorably and causes severe complications. Therefore, the patient must be under the supervision of medical staff. Home therapy is only possible in mild cases.
Antibiotic therapy
The main treatment for pneumonia in the elderly is antibiotic therapy. Before prescribing drugs, it is recommended to do a sputum test for bacterial culture with a determination of the sensitivity of microorganisms to drugs. However, sometimes it takes quite a long time to wait for the results of the study, and the treatment is urgent. Therefore, at the beginning of the disease, broad-spectrum antibiotics are prescribed, and then the therapy is adjusted depending on the results of the test for bacterial seeding.
The following antibacterial drugs are prescribed:
- Amoxiclav.
- "Benzylpenicillin."
- Ampicillin.
- Ceftriaxone.
- Erythromycin.
The duration of treatment depends on the type of causative agent of pneumonia. In most cases, antibiotic therapy lasts about 10 days. If the inflammation is caused by chlamydia or mycoplasma, then taking antibacterial drugs takes about 2 weeks.
It is important to remember that prolonged use of such drugs can trigger the development of fungal infections. During treatment, elderly patients are at increased risk of candidiasis. Therefore, along with antibiotics, people of advanced age need to take antifungal drugs (Nystatin) and vitamin complexes to strengthen immunity (Decamevit, Undevit).
Additional Therapies
Along with antibiotic therapy, symptomatic treatment of pneumonia in the elderly is carried out. At an advanced age, patients are often worried about coughing, while sputum usually disappears with difficulty. Therefore, patients are prescribed bronchodilators:
- "Eufillin."
- Euspiran.
- Salbutamol
- Berotek.
In old age, bronchodilators are recommended to be used in the form of aerosols. This allows you to reduce the drug load on the body.
To dilute sputum, elderly patients are shown the use of mucolytics:
- "Lazolvana".
- "Mukaltina."
- "ACC".
- Ambrobene.
Bronchodilators and mucolytics facilitate the patient’s breathing and help reduce hypoxia. In case of severe shortness of breath, medications that stimulate respiratory function are prescribed (Cordiamine, Caffeine).
In older people, pneumonia is often accompanied by cardiological disorders. With signs of heart failure, the use of strophanthin based cardiac glycosides is indicated. If the patient has arrhythmia, then drugs are prescribed that normalize the heart rate (Bisoprolol, Metaprolol, Verapamil).
Possible complications
Inflammation of the lungs in old age is very important to cure on time. If the diagnosis was made too late, then a long absence of therapy can lead to the following complications:
- heart and respiratory failure;
- pulmonary edema;
- blood poisoning;
- pleurisy.
It is very important not to interrupt treatment. Even if the patient's condition has improved significantly after a few days, it is necessary to complete the course of antibiotic therapy. A frequent cause of complications is the premature discontinuation of antibiotics. In this case, the symptoms of pneumonia may return, and the disease will become more severe.
Forecast
The prognosis of pneumonia in the elderly depends on several factors:
- age of the patient;
- the presence of chronic pathologies;
- state of the cardiovascular system;
- localization and spread of the inflammatory process in the lungs;
Unfavorable prognosis have bilateral, croupous and congestive forms of pneumonia. These pathologies quickly lead to the development of heart and respiratory failure.
Also of great danger is interstitial pneumonia. This disease causes irreversible sclerotic changes in the lungs, which often leads to death.
The prognosis for focal pneumonia is more favorable. With timely treatment, the disease in most cases ends in recovery. However, the presence of chronic diseases can worsen the prognosis.
Prevention
How to prevent pneumonia in old age? Doctors recommend following these guidelines:
- avoid hypothermia;
- quit smoking;
- regularly do breathing exercises;
- do not abuse drugs;
- undergo regular medical examinations and fluorography.
It is very important to prevent pneumonia in bedridden patients. It is necessary to properly care for such patients. An older person needs to be turned over every two hours. A change in body position prevents stagnation of blood. Periodically, it is necessary to massage and rub with a camphor solution of the chest area. Also bed patients need to do breathing exercises daily. This will help prevent congestive pneumonia, which often has a poor prognosis.