Pneumonia in older adults: confusion, treatment and recovery

Asthma + Lung UK explains that in pneumonia the tiny air sacs in the lungs (alveoli) swell and fill with liquid, making it harder to breathe. It is a type of chest infection; the main types of chest infection are pneumonia and bronchitis. Pneumonia is usually bacterial or viral. The commonest bacterial cause is a pneumococcal infection, and viral causes include flu, RSV and COVID-19. The NHS adds that pneumonia can follow another infection such as flu, RSV or COVID-19, and can sometimes be caused by something getting into the lungs such as water or food (aspiration pneumonia).

Pneumonia that starts outside hospital is called community-acquired. Pneumonia is not itself contagious, the charity says, but the viruses and bacteria that cause it usually are.

The NHS says symptoms can start suddenly or gradually over a few days: cough, shortness of breath, a high temperature, chest pain, an aching body, tiredness, loss of appetite, wheezing, and feeling confused. Asthma + Lung UK repeats that confusion is more common in older people. A relative who is simply "not themselves", drowsy and off their food may therefore have a chest infection even without a marked cough. That overlaps with delirium, and the cause needs to be looked for.

Some symptoms are also similar to a flare-up of COPD, bronchiectasis or pulmonary fibrosis, and pneumonia can occur at the same time as, or trigger, a flare-up, according to Asthma + Lung UK, so someone with a lung condition should follow their self-management plan and contact a healthcare professional.

The NHS advises an urgent GP appointment or NHS 111 if you have had a cough for up to 3 weeks, cough up yellow or green phlegm, have chest pain that comes and goes or occurs when breathing or coughing, or feel short of breath. Asthma + Lung UK words the cough duration as 3 or more weeks. It also lists coughing up blood.

Call 999 or go to A&E, says the NHS, if you are struggling to breathe (choking, gasping, unable to speak), have pale, blue or blotchy skin, lips or tongue, are coughing up blood, or suddenly feel confused, for example not knowing where you are. The NHS says not to drive yourself to A&E and to bring any medicines.

Anyone can get pneumonia, but Asthma + Lung UK lists a lung condition such as asthma, COPD, bronchiectasis or pulmonary fibrosis, being over 65, learning disability, a weaker immune system, poorer air quality at home, smoking, malnutrition and liver disease from heavy alcohol use as increasing the chance in the community. It says around 29,000 people die from pneumonia each year in the UK, which is why treatment should start quickly.

Asthma + Lung UK says a GP usually diagnoses pneumonia by asking about symptoms, listening to the chest and checking heart and breathing rate, temperature and blood pressure, sometimes with a pulse oximeter to check blood oxygen. A chest X-ray is usually only needed in hospital, and a phlegm sample may be taken if pneumonia may be more severe, symptoms have not improved on antibiotics, or the person is in hospital.

Antibiotics are the main treatment; the charity says most people are prescribed an antibiotic called amoxicillin, usually as tablets for 5 days, with longer courses for people with bronchiectasis. The NHS says to finish the course even if you feel better and to contact your doctor if you do not feel better after 2 to 3 days. In hospital, treatment is usually antibiotics, sometimes steroids, fluids and oxygen. Self-care advice from the NHS includes resting, drinking plenty of fluids, using paracetamol or ibuprofen if you have been told you can, covering coughs and washing hands, and not taking cough medicine or smoking. Older people often have kidney problems or take several medicines, so check with a pharmacist before using over-the-counter painkillers.

Asthma + Lung UK gives a rough timeline: fever should go after 1 week, the chest should feel better and phlegm reduce after 4 weeks, cough and breathing should ease by 6 weeks, most symptoms should be gone by 3 months though tiredness may linger, and full recovery may take 6 months. If symptoms still affect you after 6 weeks, a GP can arrange a chest X-ray. Most people make a full recovery, though pneumonia can occasionally lead to lung conditions such as bronchiectasis or pulmonary fibrosis, and you can have pneumonia more than once. Activity should be built up slowly.

The NHS lists vaccines that help: pneumococcal (recommended for babies, adults over 65 and people at higher risk), flu (adults over 65 and people with certain long-term conditions), RSV (adults aged 75 and over, and adults aged 65 to 74 with a weakened immune system or a long-term lung condition) and the seasonal COVID-19 vaccine for those at increased risk. Stopping smoking also reduces the chance of pneumonia.