1

Pneumonia in the Older Adult

Venice E. Rittler

James Madison University

PNEUMONIA IN THE OLDER ADULT 2

Abstract

Age-related changes in the older adult play a significant role in the reduction of

pulmonary health. In particular, pneumonia is one of the leading causes of death in the

geriatric patient (Mitani et al., 2018). Age-related changes such as decreased tissue

elasticity, decreased secretion clearance, and increased tissue stiffening are all

physiological changes that can lead to an increased risk for developing pneumonia. It is

crucial to create tailored health care plans to promote pulmonary health in the geriatric

population. These care plans may include increased physical activity, coughing and deep

breathing exercises, smoking cessation, and recommended annual vaccinations as well as

routine preventative care. Although age-related changes cannot be avoided, the severity

of these changes and the impact they have on overall wellbeing may be modified. This

paper examines the age-related changes as well as the prevention and treatment of

pneumonia in the geriatric patient.

PNEUMONIA IN THE OLDER ADULT 3

Pneumonia in the Older Adult

For the older adult, age-related changes can be a catalyst for disease and

decreased function, impacting overall health and well being for the geriatric patient. This

paper examines the age-related changes that are found in the respiratory system and how

this increases the likelihood for pneumonia, one of the leading causes of death in the

geriatric population.

Common Age-Related Changes

As a person ages, a major change is tissue stiffening in the respiratory tract. The

trachea stiffens due to calcification and both the elastic recoil of the lungs as well as the

alveoli stiffen, reducing gas exchange and requiring accessory muscle use and additional

effort to maintain expiration (Eliopoulos, 2018). Coughing and gag reflex is reduced,

resulting in decreased clearance of secretions and increased risk of aspiration. In addition,

the body loses skeletal muscle strength, which contributes to reduced functional capacity.

All of these changes result in a stiff lung that requires more air to get the same gas

exchange. As a result, gas exchange becomes less effective and oxygenation decreases

(Kim et al., 2017).

In addition to changes specific within the respiratory system, there are changes in

the older adult lifestyle that contribute to decreased pulmonary function as adults age.

Immobility and decreased functional ability is a major threat to pulmonary health

(Eliopoulos, 2018). A study in 2018 examined functional independence and swallowing

ability as criteria to predict the likelihood of developing pneumonia. The study revealed

that these two scores may accurately predict likelihood of pneumonia, concluding that
PNEUMONIA IN THE OLDER ADULT 4

decreased mobility and increased aspiration risk are two major age-related changes

contributing to pneumonia in older adults (Mitani et al., 2018).

Disease Prevention

For the older adult, promoting breathing exercises and appropriate body

movement is crucial to promoting pulmonary health (Eliopoulos, 2018). Educating the

patient on use of an incentive spirometer can help encourage lung expansion and

secretion movement, and it may be helpful to associate this practice with other daily

habits, such as during commercial breaks or before meals (Eliopoulos, 2018). Physical

activity such as walking, water aerobics, dance, or yoga may be other low impact

exercises to promote pulmonary health. Smoking is one of the most important factors in

respiratory health, since many older adults began smoking before the full effects of

smoking were not realized (Eliopoulos, 2018). The Doetinchem Cohort completed a

longitudinal study in 2018 evaluating the effects of smoking on lung function when

compared to normal age-related changes. They confirmed that smoking decreases lung

function over time, in addition to the normal age-related changes (Oostrom et al., 2018).

Therefore, smoking cessation is key to promoting pulmonary health. Finally, vaccination

is another recommended step to prevent the development of pneumonia. Since the older

adult has a lowered resistance to infection, the older population is encouraged to receive

pneumococcal and influenza vaccines (Eliopoulos, 2018). Since pulmonary disease is so

prevalent among the geriatric population and have such a profound impact on lifestyle

and overall health, it is crucial to created tailored care plans to prevent disease

progression and promote quality lifestyle. In 2019, Dyer and Pugh suggest that a one-

size-fits-all approach to pulmonary health promotion is less effective due to the nature of
PNEUMONIA IN THE OLDER ADULT 5

variability in disease. A decrease in lung function can lead to lifestyle adjustments

including isolation, depression, decreased mobility, and decreased oxygenation and

perfusion (Dyer & Pugh, 2019). It is essential for older adults to get tailored care to

prevent a deteriorating in pulmonary health and overall life satisfaction.

Treatment of Pneumonia

The treatment of pneumonia in the older adult is very similar when compared to a

younger patient (Eliopoulos, 2018). Treatment includes antibiotic administration, deep

breathing and coughing exercises, fluid administration, and chest x-rays to confirm

diagnosis and progress. Although standard of care may be the same, achieving these

goals may be more difficult due to decreased independence in functionality and

physiological changes. Swallowing should be assessed to ensure aspiration is not taking

placed, assisting in movement for individuals unable to effectively move every two hours

should be completed, and leading through breathing exercises are all steps that may be

necessary for the older adult when compared to a younger patient.

Conclusion

In summary, age-related changes in the respiratory system of the older adult result

in an increased risk for pneumonia, one of the leading causes of death for the geriatric

population. Pneumonia steps for prevention may include increasing physical activity,

encouraging deep breathing and coughing exercises, quitting smoking, receiving all

recommended vaccinations, and regularly receiving preventative health care checkups.

With tailored care and the proper resources, the geriatric population incidence of

pneumonia can be reduced and quality of life can be sustained.

PNEUMONIA IN THE OLDER ADULT 6

References

Dyer, C., & Pugh, L. (2019). Lung health in older adults. Age and Ageing, 48(3), 319–

322. https://doi.org/10.1093/ageing/afz008

Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Wolters Kluwer.

Kim, J., Heise, R. L., Reynolds, A. M., & Pidaparti, R. M. (2017). Aging effects on

airflow dynamics and lung function in human bronchioles. Plos One, 12(8).

https://doi.org/10.1371/journal.pone.0183654

Mitani, Y., Oki, Y., Fujimoto, Y., Yamaguchi, T., Yamada, Y., Yamada, K., … Ishikawa,

A. (2018). Relationship between the Functional Independence Measure and Mann

Assessment of Swallowing Ability in hospitalized patients with pneumonia.

Geriatrics & Gerontology International, 18(12), 1620–1624.

https://doi.org/10.1111/ggi.13543

Oostrom, S. H. V., Engelfriet, P. M., Verschuren, W. M. M., Schipper, M., Wouters, I.

M., Boezen, M., … Picavet, H. S. J. (2018). Aging-related trajectories of lung

function in the general population—The Doetinchem Cohort Study. Plos One,

13(5). https://doi.org/10.1371/journal.pone.0197250