How to Spot Pneumonia in Seniors

This lung infection can be life-threatening if symptoms aren’t identified early.

As Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure” — and that’s especially true when it comes to pneumonia in older people.

That’s because older people who are hospitalized for pneumonia have a greater risk of death compared with the other top 10 reasons for hospitalization, according to the American Thoracic Society. And pneumonia sends more than 400,000 people to emergency rooms each year, according to the Centers for Disease Control and Prevention.

“Immunity is not as robust in seniors, so it’s important to get to the doctor and take care of the earliest symptoms quickly,” says Dr. Ronald D. Adelman, co-chief of the Division of Geriatrics and Palliative Medicine at NewYork-Presbyterian/Weill Cornell Medical Center. Potential signs of pneumonia include coughing, chills, fever, and difficulty breathing.

Older people can also be prone to swallowing problems, making them susceptible to aspiration pneumonia, caused when food, saliva, or liquids are inhaled into the lungs.

Along with recognizing common symptoms, there are specific steps both seniors and younger adults can take to stave off pneumonia.

Look Out for the 3 D’s of Geriatrics

Delirium, depression, and dementia are known as the three D’s of geriatrics, according to Dr. Adelman. Delirium — or an acute confusional state — can indicate that an infection like pneumonia is brewing.

“An older person is just as likely to experience delirium, loss of appetite, dizziness, falls, or lethargy when they get pneumonia as some of the physical symptoms,” says Dr. Adelman.

“Older people with pneumonia (and other infections) are more susceptible to developing an acute confusional state, as well as rapid heartbeat and lethargy — all of which might not bring pneumonia to mind.”

But these symptoms, the more common ones like coughing or difficulty breathing, along with sweating, headache, bringing up sputum (a mixture of saliva and mucus), or clammy skin merit a doctor’s visit.

“The minute an older person who is normally functional has a precipitous decline, geriatricians make a comprehensive assessment of the patient with a careful history and physical exam, blood work, urinalysis, and often a chest X-ray to make sure something else isn’t going on,” says Dr. Adelman. “As a geriatrician, you always want to be on the lookout to see if an infection is at the root of the problem.”


“The presentation of symptoms can be much more subtle in the elderly.”

— Dr. Ronald D. Adelman


Sneaky Symptoms

One reason it’s especially important to be on alert for pneumonia in an older person: “The presentation of symptoms can be much more subtle in the elderly,” says Dr. Adelman.

Case in point: It’s typical for patients with pneumonia to have an elevated white blood cell count, but up to 50 percent of people over 65 with pneumonia have a normal white count. They may also have minimal chest sounds, and 20 percent don’t present with fever, Dr. Adelman says.

To make matters more confusing, a chest X-ray may not show pneumonia if the patient is dehydrated.

Other common signs of pneumonia like shortness of breath, coughing, fever, and chills are also not consistently present in older adults.

Prevention Is Key

Dr. Adelman says prevention begins with good hygiene — washing hands before meals and after you’ve been outside your home and exposed to others, and avoiding people with colds or the flu. And if you have a cold or the flu, practice careful hygiene — cover your mouth when you cough, wash your hands regularly, and consider wearing a mask if you are contagious.

What’s more, “people over 65 and anyone with a chronic lung condition should also be sure to get a flu vaccine as well as make sure to be vaccinated with the two types of available pneumonia vaccines,” he says. Seniors should talk to their doctor about what is best for them.

It’s crucial, too, for smokers to quit, since the habit impedes the ability of the tiny hairs (known as cilia) that line the trachea and bronchial tubes from sweeping away bacteria and sputum.

Dr. Adelman’s overall advice? “Whether a person is young or old, staying in good health, exercising, and eating well helps protect you, so that if you’re thrown a curveball, you can mount as strong a defense as possible.”