Introduction
The lung is the main respiratory organ associated with respiration. The main function of the lungs is to help in the process of gaseous exchange in the blood. However, some diseases may create hindrances in this process. Pneumonia is one of the main infectious lung diseases that may cause severe complications. Pneumonia is nothing but an infectious disorder of lung parenchyma. It is one of the main causes of death in elderly people.
What Is Pneumonia in the Elderly?
Infection of the lung parenchyma of elderly people is known as elderly pneumonia. In most cases, the infection is acquired outside the hospital. That is why it is known as community-acquired pneumonia. Other than this, elderly people who are suffering from chronic disorders may be affected by pneumonia during hospital visits. This type of pneumonia is known as hospital-acquired pneumonia. This type of pneumonia is usually acquired 48 hours after hospital administration. Immunocompromised patients may acquire pneumonia 48 hours after the endotracheal intubation. This type of pneumonia is known as ventilator-associated pneumonia (VAP).
The risk factors for developing pneumonia in the elderly population are smoking, a history of breathing disorders like asthma or asthma-COPD overlap syndrome (ACOS), and lung disorders like chronic obstructive pulmonary disorders. Other than this, systemic disorders like hypertension, diabetes, tuberculosis, and heart diseases are linked to elderly pneumonia. Conditions that are associated with reduced immunity, such as renal dysfunction, liver disorders, radiotherapy, and chemotherapy, are responsible for situations like ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia.
1. Pathophysiology
As already discussed, pneumonia in elderly people is related to deleterious habits and lung disorders. Also, reduced immunity plays a crucial role in the pathogenesis of this condition. Apart from this, impaired gag reflex and central nervous system disorders also play a vital role in the pathogenesis of this condition. Elderly pneumonia is mainly caused by bacterial infection. The microorganisms that are caused are Pneumococcus, Haemophilus influenzae, Moraxella catarrhalis, and Group A Streptococcus. Apart from this, some atypical bacteria such as Legionella, Mycoplasma, Chlamydia, and Mycoplasma pneumoniae may be associated with it. Hospital-acquired pneumonia is caused by pathogens like Escherichia coli, Pseudomonas Aerugenosa, Acinetobacter, and Enterobacter. Pathogens first invade the pharynx and then enter the lower respiratory tract through micro-aspiration. Inside the lungs, the pathogen triggers the host's pulmonary defense system. If the host's defense is compromised or the pathogen is particularly strong, pneumonia can develop. Pathogens can also spread through the bloodstream and macro-aspiration. The inflammation leads to the accumulation of cells like neutrophils, mast cells, and macrophages. Subsequently, this results in inflammation of the lung parenchyma and induces increased permeability of the lining capillaries, resulting in exudative congestion and highlighting the pathogenesis of pneumonia.
2. Symptoms:
The common symptoms associated with this condition are fever, cough, and cold. Gradually, these lead to purulent sputum, difficulty in respiration, and chest pain. In some cases, blood can be detected in sputum. In severe cases, lung infection may spread to other portions of the body and may lead to sepsis. This may cause cardiac complications, renal dysfunctions, and bleeding disorders.
What Are Treatment Options for Pneumonia in the Elderly?
The treatment option for pneumonia in the elderly can be divided into two parts;
1. Preventive Treatments:
-
All the harmful habits which may lead to pneumonia should be stopped. Habits like smoking and vaping should be prohibited. The elderly should be kept away from dust and cold places.
-
Elderly people suffering from diseases like asthma and chronic obstructive pulmonary disorders should be cautious.
-
Two vaccines are available for elderly people. These two vaccines may protect elderly people from pneumonia. These vaccines are PCV15 or PCV20. When PCV15 is administered, it is recommended to follow up with a dose of PPSV23 after one year. The interval between the two vaccines should be at least eight weeks, and this schedule can be followed for adults with specific conditions such as immunocompromising conditions, cochlear implants, or cerebrospinal fluid leaks. However, if PCV20 is used, there is no need for a dose of PPSV23.
-
23-valent pneumococcal capsular polysaccharide vaccine (PPSV23) is used in immune-compromised patients such as patients suffering from renal failure, diabetes mellitus, or chronic lung disease; if the person has received a dose of vaccine before the age of 65, a repeat vaccination is required when the cross the age of 65. However, revaccination is not required if the person is already 65 years or older. However, these vaccines are not recommended for persons who have a history of severe allergies.
2. Definitive Treatments:
-
Antibiotics are the medication of choice for persons suffering from pneumonia or community-acquired pneumonia. A high dose of penicillin is prescribed in such cases. For persons allergic to penicillin beta-lactam, antibiotics can be given. Along with this, drugs like Doxycycline, Fluoroquinolones, Monobactams, or Carbapenems can be used in these cases.
-
In severe cases, intravenous administration of antibiotics is done. However, intramuscular administration of antibiotics is another method of choice.
-
If the infection is caused by methicillin-resistant Staphylococcus aureus; P aeruginosa, Pseudomonas aeruginosa, or the patient is in a long-term care facility, respiratory fluoroquinolone, Vancomycin, and Linezolid can be added with other antibiotics.
-
Application of systemic corticosteroids like Methylprednisolone is necessary to reduce the amount of systemic and lung inflammation. Also, these drugs help reduce ICU stays and complications.
What Are the Concerns Associated with Treatment Methods?
The main concerns associated with several drugs linked to pneumonia are;
-
Severe drug interactions may happen to patients. Patients taking medications for other medical reasons like renal complications and hepatic complications are susceptible to drug interactions.
-
Prolonged use of drugs like fluoroquinolones or macrolides may cause cardiac complications like prolongation of QT interval. Also, these drugs may cause renal complications or abnormal coagulation of blood.
-
Prolonged use of corticosteroids may cause gastrointestinal bleeding and immunosuppression.
Conclusion
Pneumonia is a serious complication in elderly people. Deleterious habits, previous lung disorders, and reduced immunity are risk factors associated with this condition. Pneumonia in the elderly is considered a major factor associated with adult mortality. That is why prevention of this condition is essential. Pneumonia vaccines play a vital role in the prevention of this condition. Other than this, antibacterial therapy and corticosteroids are essential in curing this disorder.
