What Are the Risks of Pneumonia In the Elderly?

The clinical manifestations are atypical, such as hidden onset, often without cough, sputum, fever, chest pain and other symptoms. The basal body temperature of the elderly is relatively low, and their ability to respond to infection is poor. Even Streptococcus pneumoniae pneumonia rarely exhibits typical chills, high fever, rusty sputum, and large signs of lung consolidation. There are reports in the literature of elderly pneumonia, only 28% of survivors, and only 13% of non-survivors have fever during the course of the disease. The elderly have weak cough and mostly white or yellow purulent sputum, which is easily confused with chronic bronchitis and upper respiratory infections. More common are increased breathing frequency, shortness of breath or difficulty breathing. In contrast to mild or absent respiratory symptoms, symptoms of systemic poisoning are more common and can appear early, manifesting as mental weakness, fatigue, loss of appetite, nausea and vomiting, increased heart rate, arrhythmia, delirium, blurred consciousness, and severely reduced blood pressure coma. Examination of the typical signs of pulmonary consolidation is rare. There are 576 cases of pneumonia in the elderly in China, and only 13.8% to 22.5% of those with consolidation of pneumonia. Those with normal or lower white blood cells reached 38.7%. Wet lung sounds are easily confused with coexisting chronic bronchitis and chronic heart failure.

Elderly pneumonia

Compared with young people, the reasons for the significant increase in the incidence and mortality of senile pneumonia are various. Objectively, due to the aging of the body, changes in the anatomy and function of the respiratory system, the defense and immune functions of the whole body and the respiratory tract have decreased. The functional reserve of important organs such as liver and kidney is weakened or suffers from a variety of chronic serious diseases, malnutrition, etc .; the subjective reasons are that the doctor or patient has insufficient understanding of the atypical clinical manifestations of senile pneumonia, delayed diagnosis and inappropriate treatment measures.

Pneumonia signs in the elderly

Elderly pneumonia medication

Clinicians should fully consider the following characteristics of the elderly when diagnosing and treating senile pneumonia: There are obviously more basic diseases and concomitant medical problems in the elderly than young people, and they should be fully considered during treatment, taking into account both parties; The adjustment should be based on the changes after aging with pharmacokinetics; The incidence and severity of side effects of the drug increase, and should be closely observed after administration, and try to protect the aging functions of all important organs. Focus on the following:

1. Early detection and timely diagnosis.

2. Reasonable application of antibiotics Proper selection of antibiotics is the key to the treatment of senile bacterial pneumonia. Once pneumonia is diagnosed, antibiotics should be applied in sufficient quantities as soon as possible, combined with medication if necessary, and the duration of treatment should be appropriately extended. Empirical treatment can be performed at the beginning, and antibiotics can be selected by targeted drug selection or reference to drug sensitivity results after the pathogen is identified (Table 3).

Elderly people have unstable oral absorption and should be injected. Hepatic and renal dysfunction, the amount of reduction according to the antibacterial drug metabolism and excretion route, as appropriate. Renal function in the elderly has been significantly reduced, and aminoglycosides should be used with caution. Drainage should be performed when a lung abscess is formed.

The choice of antibiotics for elderly pneumonia also needs to be individualized according to the patient's condition. If the patient is not old, usually in a good state of health, without serious chronic diseases and important organ insufficiency, a more general antibiotic can be selected, and the drug should be discontinued 3 to 5 days after the body temperature, blood is normal, and the sputum turns white. . If the patient is old, has a poor basic condition, is accompanied by severe chronic disease and pneumonia complications, or has severe symptoms of pneumonia poisoning, a strong broad-spectrum antibiotic or a combination of drugs can be selected to try to control the infection as soon as possible. It is generally believed that penicillins plus aminoglycosides, or cephalosporins and aminoglycosides have synergistic antibacterial effects, while penicillins and cephalosporins have an expanded antibacterial spectrum and additive effects.

The course of treatment for this type of senile pneumonia should be appropriately extended, and the drug should be discontinued after the body temperature, blood and sputum are normal for 5 to 7 days. Chest radiographs should be reviewed during the treatment of pneumonia. In principle, antibacterials should be applied to the lung shadows to absorb them basically or completely, and at least most of them should be absorbed. However, some elderly people, especially those with COPD or long-term bedridden, can often hear a fine wet murmur at the bottom of both lungs. It is not necessary to use antibiotics for long periods of time.

3. Pay attention to comprehensive systemic treatment measures. Once the elderly pneumonia is diagnosed, they should be hospitalized, rest in bed, and keep indoor air fresh and suitable temperature and humidity. Patients with fever and shortness of breath have no significant increase in dehydration, and should be rehydration and maintain water-electrolyte and acid-base balance to facilitate sputum excretion and reduce complications. For chest pain, a small amount of analgesics can be used. Those with high body temperature should be cooled to avoid inducing or exacerbating heart failure or acute coronary insufficiency. The application of antitussive and antiasthmatic and expectorants is beneficial to relieve bronchospasm and dilution and discharge of sputum, but the application of strong antitussives should be avoided. The sputum is sticky, and those with difficulty in sputum can be given humidification treatment, turned over or carried back to keep the airway open. Hypoxemia patients are given oxygen therapy to improve patients' nutrition and correct anemia and hypoproteinemia, which is conducive to recovery. Encourage appropriate activities, pay attention to defecation and avoid exertion, and reduce the occurrence of venous thrombosis or pulmonary embolism in the limbs. The underlying diseases such as diabetes and coronary heart disease should also be actively treated.

4. To treat complications, improve the treatment level of severe pneumonia, and provide oxygen therapy for respiratory failure, apply respiratory stimulants as appropriate, and perform tracheal intubation and mechanical ventilation if necessary. People with heart failure are given strong heart diuretics or vasodilator drugs. Complications of liver and kidney dysfunction or gastrointestinal bleeding and antibiotic-related diarrhea should be treated in a timely manner.

Elderly pneumonia diet health care

1. Food therapy for elderly pneumonia:

(1) 200 grams of fresh banana root, cooked with smashed mash, add a little salt to serve. With heat-clearing and moisturizing effect. Suitable for elderly patients with pneumonia and dry stool.

(2) 1-2 Sydney, 30 grams of black beans. Wash and slice the pears, add an appropriate amount of water, add black beans, simmer them with gentle heat, and serve after cooking. Applicable to the elderly with pneumonia, lung and kidney deficiency.

(3) 6 grams of bird's nest, 9 grams of white fungus, moderate amount of rock sugar. Soak the bird's nest and white fungus in hot water, wash them, put them in rock sugar, and simmer them in water. Suitable for elderly pneumonia.

(4) Pig lungs are not irrigated, 49 sweet almonds (peeled tip), 15 grams of Chuanbei (heart removed), 1 teaspoon of ginger juice, 30 grams of honey, four flavors are tied into the lungs, and boiled Cook, even with soup. Suitable for elderly pneumonia.

(5) 30 grams of purple peeled garlic (peeled and boiled in boiling water for 1 minute), 60 grams of rice, and 5 grams of white and flour. Cook rice, white, and flour in water, then add garlic to cook porridge. Serve regularly for breakfast and dinner.

(6) 200 grams of new lily, honey and steamed soft, often eaten to nourish lungs and cough. It is suitable for the elderly with dry cough and phlegm.

2. Which foods are good for elderly pneumonia:

Drink as much water as possible, and eat easily digestible or semi-flowing foods to dampen sputum and expel sputum in time. Pneumonia is often accompanied by high fever and high body consumption, so it should provide high energy, eat high-protein and easily digestible food. You can eat more fruits to increase moisture and vitamins. Vitamin C can strengthen the body's resistance, and vitamin A is good for protecting the respiratory tract mucosa.

3. Which foods are best not to eat in elderly pneumonia:

Avoid tobacco and alcohol, use spicy spicy food with caution to avoid excessive cough.

Elderly pneumonia prevention care

Elderly people over 65 years of age, especially those with chronic heart and lung disease, liver cirrhosis, renal insufficiency, spleen deficiency, etc. Injection, effective protection rate of 60% to 80%, but each elderly person only injected once in his lifetime. When an influenza epidemic year is predicted, it is recommended to use an influenza vaccine that is close to the antigen structure of the upcoming influenza virus before the epidemic. Orally taking Bistian before the epidemic season can improve the disease resistance of patients with recurrent respiratory infections.

Etiology of pneumonia in the elderly

The pathogen is complex and difficult to identify. Senile pneumonia can be non-infectious, but the vast majority is infectious. However, the identification of the pathogen of infection is very difficult, because the identification of pathogenic bacteria is usually based on sputum culture, and the sputum is unavoidably contaminated by oropharyngeal bacteria. Because of the early application of antibiotics, about 30% to 50% of pneumonia in most studies failed to detect pathogenic bacteria. To avoid contamination of sputum specimens by upper airway colony bacteria, tracheal aspiration, fiberoptic bronchoscopy with protective brushes, chest wall skin puncture lung aspiration, or thorax lung biopsy can be used, but they are all traumatic. It is difficult to promote the application among the elderly.

According to more reliable methods of specimen source, such as research through tracheal aspiration, blood culture, and specific serological tests, the following microorganisms can be considered as the pathogen of most elderly patients with pneumonia: Streptococcus pneumoniae, Haemophilus influenzae, Aerobic bacteria, Gram-negative bacilli, Legionella pneumophila, Staphylococcus aureus and influenza viruses. Different places and environments to obtain the infection, the pathogens of senile pneumonia are also quite different, see Table 1.

Among community-acquired pneumonia (also known as out-of-hospital pneumonia), streptococcus pneumonia is the most common cause of senile pneumonia, with haemophilus influenzae bacterium taking the second place, and gram-negative bacilli are rare. In hospital-acquired pneumonia (also known as nosocomial pneumonia), Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter, Proteus and other Gram-negative bacilli are common, accounting for about 50% to 70%. Domestic Lu Weixuan reported 31 cases of senile pneumonia in the 1980s. Gram-negative bacilli accounted for 77%, of which 48.39% were Pseudomonas aeruginosa, 17.35% were Klebsiella, and 9.68% were E. coli. The difference in the pathogenic distribution of pneumonia outside and inside the hospital may reflect an increase in oropharyngeal Gram-negative colonies in elderly hospitalized patients, and serious related diseases that lead to decreased immunity and susceptibility to pathogenic bacteria. Bacterial infections occupy an important position. When anaerobic infection is suspected, it is meaningless to culture coughed sputum for anaerobic bacteria, because there are often a large number of anaerobic bacteria in the upper airway and oral cavity. Anaerobic infections are more common in patients with a tendency to aspiration, often accompanied by neurological diseases, altered consciousness, swallowing disorders, or the use of sedatives. The elderly are high-risk and vulnerable patients of Legionella pneumonia. The incidence of the disease is directly related to the age of the patient. The risk of infection over 60 years is twice that of young people. Most of the Legionella pneumoniae are sporadic, with occasional outbreaks. The epidemic occurs in hotels or hospitals and may be related to water pollution. Legionella infections are often missed like anaerobic bacteria, unless special inspection techniques are used, such as direct fluorescent antibody staining of respiratory secretions and bacterial culture in special media.

In recent years, due to the application of immunosuppressive agents and a large number of broad-spectrum antibiotics, the infection of conditioned pathogens, fungi and drug-resistant bacteria has gradually increased.

Viruses that can cause senile pneumonia include influenza virus, parainfluenza virus, respiratory syncytial virus and adenovirus. The most important thing is the influenza virus, the incidence of which is age-related, and the incidence of older people over 70 is four times that of those under 40. In the United States, which lasted for many years, elderly people over 65 accounted for 90% of influenza-related mortality.

Diagnosis of pneumonia in the elderly

The diagnosis of senile pneumonia also needs to be distinguished from other diseases that can cause lung shadows, such as pulmonary embolism, lung tumors, tuberculosis, and atelectasis.

Elderly pneumonia examination method

Laboratory inspection:

It is generally believed that the increase of white blood cells is not obvious in half of patients, and the white blood cell increase from clinical observation is generally (10 ~ 15) × 109 / L.

Other auxiliary checks:

The chest X-ray showed that the lungs were patchy, fuzzy and densely shadowed, with uneven density. Dense lesions could be fused into larger patches, and the lesions could involve multiple lung lobes widely.

Complications of pneumonia in the elderly

The condition changes rapidly and there are many complications. The same is pneumonia. Young people can be cured without antibiotics within a few days. But the elderly suffer from pneumonia. Complications such as dehydration, hypoxia, shock, severe sepsis or sepsis, arrhythmia, electrolyte disturbances, and acid-base imbalance can occur shortly after the onset of illness.

Prognosis of pneumonia in the elderly

Poor efficacy, easy to induce multiple organ failure. Factors affecting the efficacy are: local defense function and systemic immune function are low, and other basic diseases such as diabetes, cirrhosis, emphysema, cardiac insufficiency, and sequelae of cerebrovascular disease, other than infection, make the infection difficult to heal, longer-term application of antibacterial Drugs increase the resistance of pathogenic bacteria, etc., reduce the efficacy and increase mortality. Elderly pneumonia with respiratory failure, heart failure and multiple organ failure has become an important cause of death. The General Hospital of the Chinese People's Liberation Army reported 122 cases of multiple organ failure (MOF) in the elderly, of which 112 cases (92%) occurred mainly due to infection, with lung infection as the leading cause.

Pathogenesis of pneumonia in the elderly

The reasons for the significant increase in morbidity and mortality of senile pneumonia are various. Objectively, the disease is caused by the aging of the body, changes in the anatomy and function of the respiratory system, and the reduction of defense and immune functions in the whole body and the respiratory tract.