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Respiratory Changes with Aging and Susceptibility to Pneumonia

Viktoriia S. Kafando

School of Nursing, James Madison University

NSG 325: Concepts in Aging

Prof. Janelle Garman

November 14, 2021

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Abstract

Aging causes natural physical and cognitive decline, which predisposes the elderly to a variety of

diseases. This paper discusses the effects of aging on the respiratory system and how

physiological changes make older adults more susceptible to pneumonia. Decreased function of

mucociliary airway clearance, chest wall mobility, and lung compliance are structural and

functional changes of the respiratory system in the elderly. Neurological disorders, altered

mental status, swallowing problems, and inability to cough may lead to aspiration pneumonia.

These physiological changes make older adults more susceptible to pneumonia and may interfere

with their recovery. This article further discusses atypical clinical presentation in the elderly, and

treatment options that vary widely from home management to hospitalization. Awareness of

physiological changes that occur in the respiratory system can help nurses to distinguish normal

changes of aging from the disease process of pneumonia. Early recognition of pneumonia helps

to seek medical care and decrease comorbidities and deaths among the growing elderly

population.

Keywords: aging, aspiration pneumonia, elderly, geriatric, older adults, pneumonia,

respiratory system
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Respiratory Changes with Aging and Susceptibility to Pneumonia

The population of older adults, individuals 65 years and older, is expected to increase and

will make up 21 percent of the population by 2050 (Casey, 2017, p. 20). Aging itself is the

greatest risk factor that makes the elderly more susceptible to chronic and acute diseases. The

respiratory system is not an exception, which makes the elder population more prone to

respiratory diseases and impairs recovery. Henig and Kaye (2017) write that pneumonia is the

eighth leading cause of death in older adults (p. 690). Since pneumonia in older adults may not

present with typical signs and symptoms that younger adults experience, it is important for

nurses to differentiate normal physiological changes from the disease process of pneumonia and

seek treatment right away. This knowledge can improve patients’ outcomes since nurses will be

able to focus on a problem rather than degeneration changes that occur with aging. It can also

improve nursing intervention such as screening, early recognition and treatment, oxygen

maintenance, medication administration, and the promotion of general well-being for the

growing elderly population.

Effects of Aging on the Respiratory System

The physiological changes that occur in the elderly greatly affect the respiratory system

in numerous ways. Weakened respiratory muscles and decreased elasticity, size, and weight of

the lungs lead to a decline in lung function and host defenses (Casey, 2017, p. 21). With aging,

impaired function of mucus and secretion clearance that protects the upper respiratory system

from pathogen invasion along with increased bacterial colonization in the oropharynx allows

more pathogens to enter the lungs. Chest wall movement and function decrease due to

alternations in the spine, rib cartilage calcification, and loss of muscle strength. Lung capacity

and elasticity decrease with age and lead to decreased perfusion, air trapping, and ability to clear
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secretions (Henig & Kaye, 2017, pp. 690-691). The increased workload of respiratory muscles,

poor perfusion, and ventilation with pneumonia can compromise the functional abilities of the

lungs and can cause respiratory failure. Neurological changes, reduced ability to cough, and

impaired gag reflex predispose elders to aspiration pneumonia.

Pneumonia in Older Adults

Pneumonia is an acute lower respiratory tract infection that may be caused by a variety

of organisms: bacteria, viruses, and fungi. When a person has pneumonia, the air sacs in their

lungs become filled with secretions that are produced through the inflammatory process (Franco,

2017, p. 621). The frequency of pneumonia increases with age, and influences recovery,

morbidity, and mortality among the elderly. According to Henig and Kaye (2017), age itself is

the independent predictor for outcomes of pneumonia in the elderly, with mortality rates of 22.4-

33.6% for adults 65 years of age and older, and 67% for adults 90 and older (pp. 689-690).

Different categories of pneumonia are distinguished based on the site of onset or

pathogens: community-acquired pneumonia (CAP), nursing home–acquired pneumonia (NHAP),

and hospital-acquired pneumonia (HAP). CAP is a common infection of elderly adults with a 30-

40% hospitalization rate and increased risk of mortality. Streptococcus pneumoniae bacterial

infection accounts for 20-85% of CAP cases, with higher incidences in long-term care facilities

(LTCFs). Coinfection of bacterial and viral pneumonia and multidrug-resistant organisms make

diagnosis and treatment more difficult (Henig & Kaye, 2017, p. 691).

Risk Factors

Physiological deterioration of organ function, comorbidities, and polypharmacy increase

the chances of pneumonia among older individuals. Age, malnutrition, pre-existing lung disease,

chronic disease (cardiovascular, diabetes, malignancies), weakened immune system, immobility,

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poor oral hygiene, and low socioeconomic status are risk factors for aging adults. Antipsychotic

and anticholinergic drugs in particular increase the risk of pneumonia due to their sedative

effects, while corticosteroids are associated with recurrent pneumonia (Henig & Kaye, 2017, p.

690). These factors impact the symptoms and presentation of pneumonia as well as recovery and

morbidity.

Aspiration pneumonia is a lung infection caused by the aspiration of foreign particles.

The presence of nasogastric or tracheal tubes can pose risks for aspiration pneumonia. Age-

related changes in swallowing and respiratory functions, like reduced gag reflex and inability to

cough, neurological disorders, altered mental status, malnutrition, dehydration, and weakness

increase incidences of dysphasia that cause aspiration pneumonia, which can be fatal to the

geriatric population (Santos et al., 2021, p. 465).

Clinical Presentation

Elderly patients may not present with typical symptoms of pneumonia such as chills,

fever, or the production of sputum. For example, only 25-50% of older adults present with fever.

Confusion, weakness, delirium, loss of appetite, onset and recurrent falls, or deterioration of

general health are common. Exacerbation of chronic diseases, like chronic pulmonary lung

disease, heart failure, and impaired diabetic control may be other symptoms of pneumonia in the

geriatric population that delay diagnosis and treatment. In older adults with dementia, urinary

incontinence may signal the onset of pneumonia. On assessment, respirations of more than 25

breaths per minute and oxygenation below 90% can also be the only symptom of pneumonia in

older adults (Henig & Kaye, 2017, pp. 697-698).

Standards of Care
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Early identification and diagnosis as well as careful monitoring of oxygenation and

appropriate hydration are crucial to promote recovery and decrease mortality among the elderly.

Based on the pathogen, the patients’ general well-being, and their symptoms, adults with mild to

moderate cases can be treated at home or at LTCFs. According to Franco (2017), antibiotics

therapy is the most common treatment and should be started as soon as pneumonia is suspected

(p. 631). Additionally, corticosteroids are used to improve patients’ outcomes. In more severe

cases, older adults may need supplemental oxygen, extensive antibiotics, other medication

treatments, and admission to the hospital or intensive care unit (Henig & Kaye, 2017, pp. 700-

704). Frequent monitoring and evaluations, involvement of interdisciplinary teams,

implementation of necessary interventions, and adjustments to patients’ needs may help to

prevent and minimize aspirations.

One of the most common types of pneumonia among the elderly is bacterial which

accounts for 85% of death and can be prevented with the pneumococcal vaccine. Yet,

pneumococcal vaccination rates among the elderly are low for a variety of reasons, with the most

common being lack of awareness and lack of healthcare provider recommendations (Turbeville

et al., 2018, p. 287). Communication between providers, nurses, and patients is a key component

to increase awareness and assure vaccinations among the elderly.

Nurses should be aware of normal physiological changes of the respiratory system in the

elderly as well as a predisposition and atypical signs and symptoms of pneumonia and seek

medical care without delays to promote recovery and decrease mortality of the growing geriatric

population.

Conclusion
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Aging has a significant impact on the respiratory system and causes physiological

changes that predispose older adults to pneumonia. Decreased function of airway clearance,

chest wall mobility, lung elasticity, perfusion, and function are physiological and structural

changes of the respiratory system in the elderly. Decreased gag reflex, swallowing problems, and

neurological changes also predispose older adults to aspiration pneumonia. Pneumonia

characterizes by the presence of fluid in the lungs; it can contribute to morbidities and has high

mortality rates among older adults. Therefore, prevention, early diagnoses, and early antibiotic

treatment can increase patients’ recovery and promote well-being. Mild cases may be treated at

home with medications, and more severe may require hospitalization with more extensive

treatment options. Vaccinations help to prevent infections of the most common type of CAP,

decrease hospitalizations, and avoid death among the rapidly growing geriatric population.

Knowledge about the physiological changes of aging and atypical signs and symptoms of

pneumonia may alert nurses to seek diagnosis and treatment in the earlier stages of pneumonia

onset instead of confusing these signs and symptoms with other diseases or degenerative decline.

Early nursing intervention promotes patients’ well-being, increases chances of recovery, and

decreases mortality rates in the geriatric population.

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References

Casey, G. (2017). The biology of ageing. Kai Tiaki Nursing New Zealand, 23(10), 20-24.

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Franco, J. (2017). Community-acquired pneumonia. Radiologic Technology, 88(6), 621-639.

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Henig, O., & Kaye, K. S. (2017). Bacterial pneumonia in older adults. Infectious Disease Clinics

of North America, 31(4), 689–713. https://doi:10.1016/j.idc.2017.07.015

Santos, J. M., Ribeiro, O., Jesus, L. M., & Matos, M. A. (2021). Interventions to prevent

aspiration pneumonia in older adults: An updated systematic review. Journal of Speech,

Language & Hearing Research, 64(2), 464-480. https://doi:10.1044/2020_JSLHR-20-

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Turbeville, K. B., Conner, R., Johnson, E., & McGough, J. (2018). Increasing pneumococcal

vaccinations in older adults. MEDSURG Nursing, 27(5), 287-290.

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