Pneumonia Symptoms In The Elderly Might Not Be At All What You Expect
Note: This article was first posted in 2011. I’ve left it as I wrote it then, with a few new additions.
The inspiration for this article “Pneumonia symptoms in the elderly” is lying in a hospital bed at the moment – she’s my 94-year-old Mom, Gertie. I had to call an ambulance Wednesday morning as poor mom was mostly unresponsive. “Out of it” is a nice way to put her condition that morning.
After a mild panic (and some soul-searching on my part), I called for the ambulance and rode with her to our local hospital to the emergency room.
It was in ER room 4 that my education about pneumonia in the elderly began. I’m hoping this article may alert others to signs and symptoms of pneumonia of which I was unaware.
There are various types of pneumonia that can affect anyone. The two main types are either ‘bacterial’ or ‘viral.’
Bacterial pneumonia (typically caused by a pneumococcus bacteria) can be treated with the use of antibiotics. Viral pneumonia is more challenging as a virus has to run its course. There are some antiviral pneumonia treatments on the market which are purported in shortening the sickness time.
A pneumonia shot is the best prevention for bacteria pneumonia (like aspiration pneumonia) in the elderly.
For the purposes of this article, I’ll focus on bacteria pneumonia like the aspiration pneumonia my Mom had.
Update 3/30/12: My Mom died last month, Feb 15, 2012, in my arms. She died at home and asleep, as we had hoped. I learned so much in the past 5 years that I cared for her. She was my true pride and joy – caregiving for her was best job (and the hardest), I’d ever tackled.
Understanding Pneumonia Symptoms Typically Seen In The Elderly
Unlike those younger, the elderly may not show the hacking cough, fever, rapid breathing, and gasping for breath that are common signs and symptoms of pneumonia. Those signs might well be present though there are others you might not know about.
Instead, like my darling Mom, there was no indication that her right lung was drowning in fluid. No fever, no cough, no nothing except, well, there was….
There was a bit of delirium/confusion but she had been in that general mental state for at least a few months now. I chalked it up, as did her regular physician, to just getting a bit “up there.” I think we were wrong.
A quick listen with a stethoscope in the ER sent the staff scurrying for a xray machine. The confirmation of right lung pneumonia was confirmed.
Not only was it confirmed, it was advanced and it was about to be bad – very very bad – if not treated immediately.
So, here’s some typical pneumonia symptoms which might be seen in the elderly:
- Problems Swallowing
‘Dysphagia’ is a term you might hear being batted around. It simply means there’s a problem with swallowing.
I did notice this symptom but had no idea it could lead to pneumonia!
If your elderly loved one seems to have a problem swallowing (such as holding liquid in his or her mouth longer than normal), get them to a doctor.My mom’s problem swallowing was exactly what I observed – slow swallowing. With each slow swallow, a bit of liquid was escaping from her esophagus and heading down her trachea to her lung. Now really, who knew?!
Bacteria grew from this liquid as it has saliva which is very bacteria ridden. My mom actually infected herself with bacteria pneumonia!
- Sudden Onset Confusion Or Lethargy
Often, sudden onset confusion can signal an unmonitored infection in the elderly. With my Mom, it was usually a symptom of a urinary tract infection (UTI).
Mom was suddenly getting more and more confused. What used to be an active, mostly clear mind was now forgetting words, couldn’t finish sentences, and couldn’t relate her needs to me.Bacteria from the pneumonia was being bred in her body and traveling to her brain.
Note: With sudden onset confusion, the first line of defense is to get a urinary test done to rule out UTI.
- Choking On Food
Mom started choking on food fairly suddenly. I remember noticing this also. Each time she choked, she aspirated a bit of the food into that right lung.
- Holding Food In Their Mouths Longer Than They Should
My Mom would have residue left over from breakfast in her cheeks for an hour she ate. I remember thinking this was a bit strange but chalked it up to her stockpiling for lunch (not really). Holding food in their cheeks is a sign that your elderly loved one is not swallowing properly.
After she finished eating, I would check her mouth for ‘extras’ while swabbing her mouth with a moistened foam swab. That way, I knew that there was noting left. She liked these mint flavor foam swabs the best.
- Chest Pain, Difficulty Breathing, Coughing Up Greenish Sputum
- Bluish lips, fingernails.
This symptoms shows a lack of oxygenated blood flowing through the body.
- Reporting of Sharp, Stabbing Pains When Breathing
Aspiration Pneumonia Was The Diagnosis
The ER doctor diagnosed Mom’s aspiration pneumonia almost immediately and put mom on a heavy dose of antibiotics.
He did take us aside though and tell us that he sees pneumonia in the elderly frequently and felt that her chances of survival were about 40%.
I had my doubts, knowing Mom as well as I did. But, we got the DNR (do not resuscitate) paperwork ready as she had years ago requested, even said a few goodbyes.
But, then again, the doctor didn’t know my Mom…
After spending a restless night in a double room, the next morning found Gert much more alert and “pink” – my job in the family as the caregiver is to keep her “pink” – my brother’s job in the family is to handle the money so he keeps her “green.”
Anyway, at 6 am, I had her sitting up in a chair, sipping coffee. When the doctor walked in, she immediately gave him her hand and said “thank you.”
His jaw just dropped.
He could not believe how she had responded in 24 hours to the antibiotics. But, then again, he didn’t know my Mom.
He took me aside and said that her chances were now about 60%. I personally thought her chances are 100%…And, I was right.
We had another great 6 months before Mom died in my home, peacefully, on February 15, 2012.
So, What Does A Diagnosis Of Aspiration Pneumonia Mean?
Luckily for us, my mom’s was bacterial so could be treated with IV antibiotics.
But, the question remained; how the heck did she get bacterial pneumonia?
I’m very careful about when and where I take my mom out. I make sure that visitors are healthy, wash their hands. etc.
Turns out that my mom infected herself! My mom’s pneumonia was caused by some problems swallowing. Each swallow was sending a bit of saliva with bacteria into her lung where she was basically drowning in liquid.
Thickening Agents Added To Liquids May Help Prevent Aspiration Pneumonia
To prevent further pneumonia from occurring, all liquids had to be thickened.
That’s right; you know how your elderly loved one’s doctor said to make sure your friend stays hydrated and drinks 8 glasses of water a day? Well, he was right, it’s just that swallowing may be an issue in the elderly.
If your elderly friend has had a stroke, a TIA (transient ischemic attack aka a mini stroke), has Parkinsons, dementia, or Alzheimer’s, they are at risk for a weakened swallowing response.
My mom probably had a few TIAs (which cannot be prevented and usually don’t cause much damage) which probably weakened her swallow. As mentioned above, a bit of each sip of water was going into my mom’s lung.
So, she still needs hydration but she has to have her water thickened now so that it “goes down the right pipe.”
As I understand it, there’s various degrees of thickening which might be needed. The two most common are “nectar thick” (just slightly thickened) to “honey thick” which is, well, the consistency of honey. That’s what my mom needed right then.
So, each spoonful of water I gave her had to be the consistency of honey. Not as bad as you might think actually as the thickeners on the market are tasteless and odorless. it does take a bit of getting used to though to “drink” thick water!
UPDATE: I wrote the above yesterday before Mom had to do a barium swallow study so the doctor could see exactly where the problem was with her swallowing. Well, the study showed that she was swallowing perfectly! No more thickening but she is instructed to take tiny sips and “swallow HARD” so that all liquid goes down the esophagus. Good news though!
Thickening Agents On The Market
We used the ‘Thick-It’ brand of thickener for the days we needed it. It is odorless, tasteless – just thickens liquids. Today you can buy pre-thickened water, cranberry juice – you name it, it’s thick!
Thick-It 36 OZThick-It AquaCare H2O: Pre-Thickened Apple Juice, Honey-thick liquid, (1 Case: 24 x 8 oz. Bottles)Hormel Thick & Easy Instant Food Thickener (Nectar Consistency), 0.16-Ounce Packets (Pack of 100)Thick-It AquaCare H2O: Pre-Thickened Water, Nectar-thick liquid, (1 Case: 24 x 8 oz. Bottles)Thick-It AquaCare H2O: Pre-Thickened Cranberry Juice, Nectar-thick liquid, (1 Case: 24 x 8 oz. Bottles)Hormel Thick & Easy Hydrolyte Thickened Water, Lemon Flavor (Nectar Consistency), 4-Ounce Portion Control Cups (Pack of 24)Thick-It AquaCare H2O: Pre-Thickened Apple Juice, Nectar-thick liquid, (1 Case: 24 x 8 oz. Bottles)
Steps To Take To Prevent Aspiration Pneumonia In The Elderly
- Change positions many times a day.
Especially for an elderly bedridden person, it’s very important to raise the head with either a special adjustable bed frame or by propping up with pillows. Laying in one position for lengthy periods is a huge no-no.
- Sit in a chair. Even if your elderly friend is bedridden, it might be possible to transfer him or her to a chair for sitting up a few hours a day. Even a few minutes can help in clearing fluid from the lungs.
- Monitor meal times. Give the elderly a softer diet which will not require as much chewing. Chicken or fish is preferable over to a juicy steak, although that’s certainly allowed within reason. Cut food items into very small pieces and remind your senior citizen friend to chew thoroughly and swallow HARD.
- Get the elderly a pneumonia shot every 5-8 years. My mom had the shot 5 years ago and, as can be seen from her experience, it doesn’t always prevent pneumonia, but it sure is better to take the chance with the shot than to skip it. I will make sure that she is inoculated against pneumonia while she’s here in the hospital.
- f swallowing is a known issue, use the proper food thickener – make sure you know if your senior friend needs “nectar thick” or “honey thick”. Feed a pureed diet. Anything can be pureed.
If you need to thicken soup, add in some mashed potatoes or piece of soft bread before you puree.
- Good dental care is a must. Brushing the teeth twice a day is necessary to keep the mouth as clear of bacteria as possible. Swab the mouth with a soft cotton swab and mouth wash at least 4 times a day.
- Give your elderly loved one some Biotene products. Biotene acts as artificial saliva. As we age, we don’t produce as much saliva as in our youth so our mouths collect more bacteria. Using Biotene helps moisten the mucus membranes of anyone with saliva issues.
Biotene is the best product for any kind of mouth dryness.
- Change positions many times a day.
Biotene Mouth Spray, Gentle Mint, 1.5 oz 2 CountBiotene Fresh Mint Mouthwash for Dry Mouth Relief, 16 ounce (Pack of 2)Biotene Toothpaste Gentle Mint Fluoride 4.3 Oz, 2 packBiotene Moisturizing Oral Rinse, Mild Mint 16 OunceBiotene OralBalance Moisturizing Gel Flavor-Free, Alcohol-Free, for Dry Mouth, 1.5 ounce (Pack of 3)Biotene Oralbalance Dry Mouth Moisturizer Gel 1.50 oz ( Pack of 5)