Pneumonia in Older Adults: Prevention and Recovery

Who is at higher risk

• Age over 65, and especially over 75.
• Chronic conditions: COPD, asthma, heart failure, diabetes, kidney disease, liver disease; see COPD and chronic lung disease, heart failure at home and diabetes at home after 60.
• Smoking or exposure to smoke and pollution.
• Weak immunity: cancer treatment, steroids, some arthritis treatments, HIV, malnutrition.
• Swallowing problems after stroke, in Parkinson's disease or dementia, which cause food or saliva to enter the lungs (aspiration pneumonia); see swallowing problems and dysphagia and aspiration pneumonia prevention.
• Being bedridden or immobile, or recently in hospital or having surgery.
• Poor dental hygiene, dentures that do not fit, or gum disease; see oral health and general health in seniors.
• Recent viral illness: flu, COVID or a bad cold.
• Alcohol excess, sedative use, low consciousness.
• Malnutrition and frailty; see frailty in older adults.
• Crowded or poorly ventilated living, and indoor air pollution.

Prevention

### Vaccines

Vaccines are among the best protection. Ask the doctor about:

• Pneumococcal vaccines, which protect against the commonest bacterial cause; recommended for adults over 65 and for younger people with chronic conditions, in schedules the doctor will explain.
• Yearly influenza vaccine, since flu often leads to pneumonia.
• COVID-19 vaccines and boosters as advised.
• Other vaccines such as whooping cough and RSV, where recommended and available.

See vaccines for older adults in India and vaccines for lung health after 60. Vaccines do not give complete protection, but they reduce the chance and severity of illness.

### Everyday habits

• Stop tobacco and avoid second-hand smoke; ask the doctor about support.
• Keep the home well ventilated, and reduce indoor smoke from cooking fires, incense and coils; see indoor air quality for older lungs and pollution season plan for seniors.
• Wash hands often, and avoid contact with people who are unwell; use masks in crowded places during infection seasons if advised.
• Treat colds and flu sensibly: rest, fluids; call the doctor if a cold worsens, breathing becomes difficult or fever returns.
• Stay active and keep moving even when unwell, as much as safe: lying flat for long periods allows secretions to collect.
• Eat well, maintain weight and protein; see malnutrition in older adults and how much protein do seniors need.
• Limit alcohol and sedatives, which dull coughing and swallowing reflexes.
• Control chronic diseases: blood sugar, heart failure, COPD.
• Avoid unnecessary sedating medicines; see polypharmacy and deprescribing.

### Mouth care and swallowing

The mouth harbours bacteria that can be inhaled. Brush teeth and gums twice a day, clean dentures daily and remove them at night, see a dentist regularly, treat mouth sores and dry mouth. See oral care for frail older adults. For people with swallowing problems: sit fully upright to eat and drink and for 30 minutes after; take small mouthfuls; follow the speech therapist's advice on food texture and thickened fluids; do not feed a drowsy person; keep the head raised in bed; report coughing at meals, a wet voice or repeated chest infections. See soft and pureed diets.

### Positioning and mobility

For bed-bound people, change position regularly, keep the head of the bed raised, encourage deep breathing and coughing, and help with sitting out of bed when possible; see backrests for sitting up in bed and positioning a bedridden parent.

Warning signs

Pneumonia in older adults can be subtle. Suspect it when there is:

• New or worse cough, with or without phlegm (yellow, green or rusty);
• Fever or chills, though some older people have only a mild temperature or even a low one;
• Fast breathing or breathlessness, with or without chest pain on breathing in;
• New confusion, drowsiness, agitation or a fall;
• Loss of appetite, weakness, or "just not right";
• Fast heartbeat, low blood pressure, sweating or shivering;
• Blue lips.

Check temperature with a thermometer; see digital thermometer guide and fever in older adults. A pulse oximeter may show low oxygen, but a normal reading does not rule out pneumonia, and readings can be unreliable; see pulse oximeter guide and pulse oximeter accuracy limits. Count breaths for a minute at rest: persistently above about 24 breaths a minute is concerning.

What to do

Call 112 immediately if there is severe breathlessness, difficulty speaking in sentences, blue or grey lips, confusion or drowsiness that is marked, chest pain, collapse, very fast heartbeat, or oxygen saturation that the doctor has told you is dangerously low. Sit the person upright while waiting.

See a doctor the same day for any suspected pneumonia in an older adult, even without high fever. Diagnosis usually involves examination, oxygen level, a chest X-ray and blood tests. Treatment depends on severity: mild cases may be treated at home with medicines prescribed by the doctor and close follow-up; moderate and severe cases need hospital care, oxygen, intravenous medicines and fluids. Do not give leftover antibiotics or cough suppressants, or start medicines yourself; do not delay. Tell the doctor about vaccinations, medicines, previous chest problems and recent hospital stays.

Home care during recovery

If the doctor agrees that treatment can be at home, or after hospital discharge:

• Take all prescribed medicines exactly as directed, and finish the course unless the doctor says otherwise. Do not stop because you feel better; do not double up for missed doses; ask the doctor.
• Rest, but do not stay flat in bed; sit up in a chair for meals and part of the day; change position regularly.
• Drink plenty of fluids to loosen phlegm and prevent dehydration, unless fluids are restricted (as in heart failure); see hydration for older adults.
• Eat small, nutritious meals with protein; supplements as advised; see indian meals for high-protein seniors.
• Breathing exercises: slow deep breaths, pursed-lip breathing, gentle coughing to clear phlegm, as shown by a physiotherapist; see breathing exercises for seniors and respiratory physiotherapy for elderly lung health.
• Monitor temperature, breathing, alertness, appetite and fluid intake; keep a diary; if the doctor advised, check oxygen levels and note them.
• Keep the room comfortable and well ventilated; avoid smoke and strong smells; consider a humidifier only if the doctor advises, with careful cleaning.
• Steam inhalation can cause burns; use only as the doctor advises and with great care; see steam inhalation safety.
• Avoid cough suppressants and sedatives unless prescribed; coughing helps clear the lungs.
• Mouth care and clean dentures.
• Prevent complications: pressure sores, constipation, blood clots, falls; see preventing bedsores at home and monitoring a parent after hospital discharge.
• Watch for delirium; see delirium in older adults.
• Isolate from others where advised, with hand washing and covering coughs; see infection control for home caregivers.
• Follow up: a doctor's review within a few days; a repeat chest X-ray in some cases, several weeks later, to check the lungs have cleared, particularly in smokers and older adults.

Return to the doctor or call 112 if breathing worsens, fever persists beyond two to three days of treatment, confusion appears, the person cannot drink or eat, chest pain develops, lips turn blue or the person becomes drowsy.

Rebuilding strength

Recovery can take weeks, and tiredness may last longer. After the acute phase:

• Increase activity gradually: sitting out, short indoor walks, then longer; see walking programme for older adults and chair exercises for seniors.
• Pace activities, rest when needed and use a walker if unsteady.
• Eat well and keep hydrated.
• Return to normal activities slowly.
• Avoid crowds and pollution for a time; keep vaccines up to date.
• Ask the doctor about pulmonary rehabilitation for those with chronic lung disease.

See post-covid and post-infection fatigue in seniors and pneumonia care for seniors.

Special situations

• Dementia: pneumonia often presents as sudden confusion; feeding and swallowing may be affected; see dementia, eating and weight loss. Hospital treatment decisions should reflect the person's wishes and best interests; see advance care planning in India.
• Stroke and Parkinson's: swallowing safety is key; see stroke recovery at home guide and Parkinson's disease at home.
• Advanced illness: pneumonia may be a final illness; palliative care can ease symptoms; see palliative care at home guide.
• Tuberculosis can mimic pneumonia and should be considered in persistent cough, weight loss and night sweats; ask the doctor.

Family and carers

Be alert to change; keep the vaccination record; keep emergency numbers visible; support mouth care and safe feeding; keep a log of readings and medicines; look after yourself; see caregiver burnout signs and prevention.

When to ask a professional

A doctor diagnoses and treats pneumonia. A chest physician helps with recurrent or severe cases. A physiotherapist teaches breathing and clearing techniques. A speech and language therapist assesses swallowing. A dentist looks after mouth health. For senior services, call Elderline 14567. In an emergency, call 112.