Pneumonia in Nursing Homes

Pneumonia is an inflammatory lung infection that is a serious problem for those over the age of 65. Seniors are much more likely to develop complications due to other illnesses being present. In nursing homes, the likelihood of death from pneumonia is even greater, with at least 1 out of 20 patients succumbing to the illness. Due to this, it is important that the potential causes and symptoms are understood to ensure treatment is started as soon as possible.

Causes of Pneumonia

Pneumonia is inflammation that occurs in the lungs due to bacteria, fungi, viruses and other types of bacteria. When the inflammation occurs, it causes fluid to collect in the areas of the lungs that are infected, which makes breathing difficult. As a result, oxygen levels in the bloodstream often decrease as well – especially in older patients. As the infection, which can be in one or both lungs, occurs, it causes the blood flow to decrease to other parts of the body to ensure oxygen gets to the vital organs. As a result, even though the infection is in the lungs, it can cause serious complications, including kidney failure, low blood pressure and bloodstream infections such as bacteremia.

Symptoms of Pneumonia

Elderly patients who are suffering from pneumonia often have other illnesses and conditions that not only increase the effects of the infection, but also make it harder to recognize the symptoms. The cough, fever and chills that are often present in younger people may not always be present in seniors. When you add the fact that pneumonia can be caused by over 30 different organisms, the symptoms can often vary widely. There are, however, some common symptoms that may indicate an infection in older patients:

  • Confusion
  • Cough with yellow or green sputum
  • Weakness
  • Fatigue
  • Fever
  • Shortness of breath
  • Chest pains
  • Chills

Some elderly patients may also experience dizziness or sleepiness, or show a marked lack of appetite. As these symptoms may be present already due to other conditions, it can make diagnosing pneumonia difficult for those who are in nursing homes.

Diagnosis

While discovering that a patient is suffering from pneumonia may be difficult, the initial diagnosis after it is suspected is relatively easy. In most cases, the inflammation from the illness can be heard as bubbling and rattling in the lungs, which are known as rales and rhonchus respectively. Another test, called a pulse oximetry test, is also used to determine the levels of oxygen in the patient’s blood. After this, a CT scan or a chest x-ray is used to locate the infection, and determine the seriousness. In many cases, the sputum may also be tested to determine which organism is causing the infection.

In the elderly in nursing homes, pneumonia is typically caused by a virus or bacteria. Pneumococcal or streptococcus bacteria is the cause most often seen in nursing homes, and it is responsible for approximately 40,000 deaths each year. This strain of the illness can cause damage to the lungs, bacteremia and meningitis in some patients. While not as frequent, pneumonia can be caused by Staphylococcus aureus or gram-negative bacteria. Patients with Staphylococcus aureus often end up on a respirator, or die quickly from the infection.

Treatment

In nursing home settings, there are strict guidelines in place for the treatment of bacterial pneumonia, which always includes antibiotics. However, due to the increase in antibiotic resistance, it can be difficult to determine which antibiotic option will work best in each situation.

Pneumonia that occurs in a nursing home is serious, and requires immediate action as soon as the illness is discovered. Swift treatment can make a major difference in the outcomes, depending on the other illnesses the patient has.

Sources:

http://www.cdc.gov/pneumonia/index.html

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