Pneumonia symptoms in elderly patients can be very subtle. As a hospitalist, I admit several elderly patients with pneumonia every week. In my experience early diagnosis is the most important factor consistently associated with a good outcome.
Unfortunately, most elderly patients or their caregiver do not recognize the early symptoms. By the time they are admitted to the hospital, most of them already have complications.
Elderly patients, especially ones that have decreased mobility, have a blunted response to any infection. Pneumonia is the infection of lungs. Normally, you can relate to pneumonia symptoms at two distinct levels: the organ level and the body level. At the organ level, you will see pneumonia symptoms that arise from injury to the lungs. These are symptoms related to breathing and include cough, shortness of breath and chest tightness.
The lungs of elderly patients may not be able to react promptly to the infection. They may not be able to cough strongly and may not be aware of the swallow breathing. As a result some elderly patients do not complain of cough or shortness of breath. They may only describe their symptom as an uncomfortable feeling in the chest.
At the body level, pneumonia normally produces symptoms typical of an infection. In younger patients, bacterial infection causes certain reactions in the body that are designed to fight the infection.
The immune system produces certain chemicals and special proteins that produce an inflammatory response.
In essence, the body goes into a fighting mode. The temperature goes up, heart rate goes up and metabolism speeds up to produce a hostile environment for the evading bacteria. The body of an elderly patient may not be able to react this strongly. They may not be able to raise the body temperature and mount a fever. They may only have weakness and lethargy.
In most cases, if you look closely, you will find that the body is trying to mount an inflammatory response but is not completely successful. The patient may be feeling cold and shivering as the body tries to increase the temperature. The patient may have a decreased appetite as the body is trying hard to produce inflammatory chemicals. The patient may get slightly confused as the body is struggling to fight the infection.
In short, caretakers of the elderly must pay attention to any change in their normal appearance, behavior or feeling and ask themselves if this could be the body’s response to an infection in the lungs.
The actual symptoms vary and are unpredictable but you can put the pieces together and link them to the lungs and the failed inflammatory response.
If you can take your grandma to the hospital while she is just starting to have these symptoms, you can probably save her life. If you wait until her body is completely overwhelmed with infection, she may already have organ damage before the doctor can start the treatment.
I would like to ask you to help me spread this message so that we can work together to save more lives. Please share this article with people you know that take care of or have an elderly person in the family.
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Nabin Sapkota, MD, is board certified in internal medicine, a hospitalist with Inpatient Physician Associates of Columbus and a physician with the hospitalist program at Columbus Community Hospital. You can read about his new book project “Symptoms and Diagnosis” at www.symptomsdiagnosisbook.com.