Pneumonia in the elderly is quite common. This pathology is especially susceptible 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 features 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 are age-related changes in the lung tissue. During this period of life, the human respiratory organs are distinguished by the following features:
- The walls of the lung vesicles (alveoli) become thinner and lesselastic.
- There is atrophy of the bronchial and tracheal mucosa.
- Ventilation capacity of the lungs deteriorates.
- Too deep inhalation and exhalation delay are often noted. This is due to the fact that the lungs of an elderly person take in an excessive amount of air.
- The cartilages of the bronchi and trachea undergo dystrophy.
These age-related changes lead to impaired gas exchange, oxygen starvation of tissues and an increase in the concentration of carbon dioxide in the blood.
Provoking factors
There are various adverse factors that increase the risk of pneumonia in older 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. The compressed tissue is very susceptible to infection and easily inflamed.
- Diseases of the internal organs. In old age, cardiovascular pathologies, diabetes mellitus, and kidney disease are often noted. All these ailments can provoke inflammation of the lung tissue.
- Frequent hospital stays. In old age, various chronic pathologies often worsen, and old people have to go to the hospital. Doctors distinguish nosocomial (hospital) form of pneumonia. This pathology can occur a few days after the patient is admitted to the hospital. This type of pneumonia occurs in patients after bronchoscopy, as well asafter surgical interventions. Ventilated patients also have an increased risk of pneumonia.
- Smoking. As already mentioned, in old people, lung tissue undergoes age-related changes. Therefore, the effects of nicotine on the respiratory system becomes especially dangerous.
- Uncontrolled use 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 severe if the patient's history has 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 identified:
- cough (dry or wet);
- breathing difficulties;
- blue fingers;
- temperature increase;
- heaviness and pain in the chest.
However, in old age, the usual clinical picture of pneumonia is far from always observed. 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. Oftenpneumonia in the elderly is accompanied by pain in the heart or dyspeptic symptoms. In addition, many other chronic pathologies exacerbate during pneumonia in the elderly.
Pneumonia in the elderly is often accompanied by extrapulmonary manifestations:
- apathy;
- drowsy;
- incontinence;
- disorders of consciousness;
- pain in the legs due to venous congestion;
- 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:
- unilateral focal;
- gross;
- double-sided;
- stagnant;
- interstitial.
Next, we will consider in detail the symptoms and features of pneumonia in the elderly, depending on the type of pathology.
Local form
Unilateral focal pneumonia occurs more often 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 high fever and tachycardia. Elderly patients are very difficult to tolerate the disease.
Pneumonia in older people over 85 often occurs in a macrofocal form. In this case, a large segment of the respiratory organ is affected. There is a decrease in the volume of the chest from the side of the inflamed lung. This pathology is accompanied by rapid and difficult breathing, as well asfeeling short of breath.
Croupous shape
In lobar pneumonia, an entire segment of the lung becomes inflamed. Often the pathological process passes to the pleura. 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 a strong fever and a sharp deterioration in well-being. In elderly patients, the temperature is usually moderately elevated, and a blood test shows only a slight leukocytosis. The disease often proceeds in an erased form. Often lobar pneumonia begins with pain in the heart, similar to an attack of angina pectoris. This makes diagnosis much more difficult.
Elderly patients complain of dry cough. At the same time, sputum leaves them with difficulty. Such an erased clinical picture of the disease is a great danger. In old people, heart and respiratory failure develops very quickly against the background of lobar pneumonia. Such complications are accompanied by a serious deterioration in the condition:
- severe shortness of breath;
- blue skin;
- passing out.
Due to oxygen deficiency, brain hypoxia develops, which leads to irreversible neurological changes. In the presence of complications, croupous pneumonia in the elderly ends fatally in 30-40% of cases.
Bilateral pneumonia
In this pathology, inflammation is diagnosed in both lungs. It can be focal, in thiscase, 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 occurs in a focal form. In this case, the following symptoms are noted:
- temperature increase (up to +40 degrees);
- breathing difficulties;
- blue skin;
- chest pain;
- cough aggravated by movement.
The disease has a poor prognosis, as 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 arousal.
Congestive Pneumonia
This type of pathology occurs in bedridden patients. The cause of the disease is a violation of blood circulation and the addition of a bacterial infection. Congestive pneumonia in the elderly is often disguised as signs of an underlying pathology. For example, in bedridden patients with a stroke, neurological symptoms may be noted at the onset of the disease. Also, in patients with hip fractures, the initial manifestations of pneumonia may be bone pain. Therefore, detecting congestive pneumonia at an early stage is quite difficult.
The classic signs of pneumonia in the elderly often appear only at an advanced stagediseases. This is expressed in the following symptoms:
- slight increase in temperature (up to +38 degrees);
- wet cough;
- sputum discharge mixed with pus and blood;
- loss of appetite;
- nausea.
Congestive pneumonia is always accompanied by disorders of the heart: pain in the sternum, arrhythmia, interruptions. In some cases, in older people, the pathology proceeds atypically. There are no respiratory symptoms, but dyspeptic symptoms occur (diarrhea, nausea, vomiting).
The danger sign is rapid breathing (more than 20 breaths per minute) and a feeling of suffocation. Such symptoms indicate damage to a large area of lung tissue. As a result of hypoxia, patients develop disorders of the central nervous system. The patient sleeps most of the day, his speech becomes incoherent.
Interstitial shape
In 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.
Interstitial pneumonia is accompanied by the following symptoms:
- short of breath;
- chest pain;
- increased sputum production;
- anxiety;
- constant feeling of hunger;
- an increase in temperature to subfebrile figures.
This is one of the most dangerous forms of pneumonia. Fibrouschanges in the tissues are steadily progressing, which leads to severe respiratory disorders and heart failure. With extensive sclerotic lesions of the lungs, the prognosis of the disease is unfavorable.
Diagnosis
Pneumonia in the elderly is very often atypical, with blurred symptoms. This pathology can masquerade as many other senile diseases. Because of this, the diagnosis of pneumonia is significantly difficult.
Doctor auscultating a patient. It is important to differentiate pneumonia from cardiovascular disease, neurological disorders, and tuberculosis. For this purpose, patients are prescribed the following examinations:
- lung X-ray;
- bronchoscopy;
- clinical blood and urine tests (for signs of inflammation);
- sputum examination for bakposev (with determination of pathogen sensitivity to antibiotics);
- MRI and CT of lungs.
Pneumonia in the elderly is most often treated 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.
Antibacterial therapy
The main treatment for pneumonia in the elderly is antibiotic therapy. Before prescribing drugs, it is recommended to do a sputum analysis for bakposev to determine the sensitivity of microorganisms to drugs. However, waiting for the resultsresearch sometimes takes quite a long time, and treatment is urgent. Therefore, broad-spectrum antibiotics are prescribed at the onset of the disease, and then therapy is adjusted depending on the results of the culture test.
The following antibacterial drugs are prescribed:
- "Amoxiclav".
- "Benzylpenicillin".
- "Ampicillin".
- "Ceftriaxone".
- "Erythromycin".
The duration of treatment depends on the type of pneumonia pathogen. In most cases, antibiotic therapy lasts about 10 days. If the inflammation is caused by chlamydia or mycoplasma, then it is necessary to take antibacterial drugs for about 2 weeks.
It is important to remember that long-term use of such funds can provoke the development of fungal infections. During treatment, elderly patients are at increased risk of candidiasis. Therefore, along with antibiotics, elderly people need to take antifungal drugs ("Nystatin") and vitamin complexes to strengthen immunity ("Dekamevit", "Undevit").
Additional therapies
Together with antibiotic therapy, symptomatic treatment of pneumonia in the elderly is carried out. In old age, patients are often bothered by coughing, while sputum is usually difficult to come off. Therefore, patients are prescribed bronchodilators:
- "Eufillin".
- "Euspiran".
- "Salbutamol".
- "Berotek".
In old age, bronchodilators are recommended in the form of aerosols. This allows you to reduce the drug load on the body.
Mucolitics are indicated for thinning sputum in elderly patients:
- "Lazolvana".
- "Muk altina".
- "ACC".
- "Ambrobene".
Broncholytics and mucolytics facilitate the patient's breathing and help reduce hypoxia. In severe shortness of breath, drugs that stimulate the respiratory function are prescribed ("Cordiamin", "Caffeine").
In the elderly, pneumonia is often accompanied by cardiological disorders. With signs of heart failure, the use of cardiac glycosides based on strophanthin is indicated. If the patient has an arrhythmia, then prescribe drugs that normalize the heart rate ("Bisoprolol", "Metaprolol", "Verapamil").
Possible Complications
Inflammation of the lungs in old age is very important to heal in time. If the diagnosis was made too late, then a long absence of therapy can lead to the following complications:
- cardiac and respiratory failure;
- pulmonary edema;
- blood poisoning;
- pleurisy.
It is very important not to interrupt the treatment. Even if the patient's condition has improved significantly after a few days, it is necessary to complete the course of antibacteri altherapy. A common cause of complications is premature discontinuation of antibiotics. In this case, the symptoms of pneumonia may return, and the disease will become more severe.
Forecast
Prognosis of pneumonia in the elderly depends on several factors:
- age of patient;
- presence of chronic pathologies;
- state of the cardiovascular system;
- localization and spread of the inflammatory process in the lungs;
Bilateral, croupous and congestive forms of pneumonia have a poor prognosis. These pathologies quickly lead to the development of heart and respiratory failure.
Interstitial pneumonia is also a big danger. 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 advise following these guidelines:
- avoid hypothermia;
- quit smoking;
- do breathing exercises regularly;
- do not abuse drugs;
- get regular medical checkups and x-rays.
It is very important to prevent pneumonia in bedridden patients. It is necessary to properly care for such patients. elderlythe person needs to be turned every two hours. Changing the position of the body prevents stagnation of blood. Periodically, it is necessary to carry out massage and rubbing with a solution of camphor of the chest area. Also, bedridden patients need to do breathing exercises daily. This will help prevent congestive pneumonia, which often carries a poor prognosis.
