Inflammatory diseases of the lower respiratory tract are often a problem in older age. Pneumonia in the elderly is an urgent problem in modern medicine. About 50% of pneumonia in this population group ends in severe complications or death due to untimely access to a doctor and hospitalization with congestive, severe forms of the disease.
There are several classifications of pneumonia accepted by the medical community that are not tied to age groups.
Distinguish out-of-hospital and nosocomial forms of pneumonia. Community-acquired pneumonia is a pathology that develops outside medical institutions or within 48 hours after admission to the hospital. And nosocomial damage to the pulmonary structures is considered nosocomial , which arose while being in hospital for more than 48 hours.
Community-acquired pneumonia is:
- with immunodeficiency;
- without suppression of immunity;
Hospital-acquired pneumonia is divided into:
- resulting from aspiration of the respiratory tract;
- appeared in patients on mechanical ventilation;
- pneumonia after transplantation.
Pneumonia after medical intervention occurs due to:
- frequent hospitalizations;
- long-term infusion therapy;
- long stay in a nursing home.
According to the spread of the process in the bronchial tree, pneumonia is:
- focal is a small inflammatory process in the lung;
- segmental – affects 1 or more pulmonary segments;
- lobe – affects the entire lobe of the lung;
- drainage – begins with small foci, which later combine into one or more large ones;
- total – extends to all the lungs.
The duration of pneumonia is:
The acute form is divided into a fast-flowing one, which lasts up to 3 weeks and a protracted form up to 2 months. Subacute lasts 3-6 weeks. The chronic form is characterized by a weak clinic and can last from six months to several years.
Causes of the disease
The etiology of pneumonia in the elderly differs in terms of factors and causes.
Factors of occurrence:
- heart failure;
- chronic obstructive pathologies of the respiratory system;
- diseases of the nervous system;
- violation of glucose metabolism – diabetes mellitus;
- long stay in hospitals and intensive care units;
- living in dark, damp rooms;
- a sedentary lifestyle (older people often lie down);
- taking drugs that reduce immunity;
- decreased muscle strength.
The causes of pneumonia in elderly people are different. Older people are almost always weakened, making it easier for infections to enter the lower respiratory tract.
Pneumonia is caused by many infectious agents, including:
- bacteria (pneumococci, staphylococci, chlamydia, legionella );
- mushrooms (mold, yeast and other types);
- viruses (types of influenza and other viral particles).
In a group of elderly people who are inpatient treatment in a serious condition, the cause may be ventilation ingestion of microflora through a tracheostomy into the lungs or frequent aspiration of various contents into the respiratory tract.
The main symptoms of pneumonia are:
- fever (high temperature);
- coughing up phlegm;
- chest pain;
- changes on a chest x-ray.
But in old age, pneumonia has its own clinical features. The onset of the disease is often invisible to both the elderly person and his environment.
Often, functional disorders of the nervous system are added, which can initially be regarded as circulatory disorders in the brain (strokes). However, they are the result of a severe pathological process in the lungs. There may be a prolonged low-grade fever (37-38 ° C), while there are practically no symptoms.
The peculiarity of pneumonia in old people is a blurred picture of the disease with manual methods of examining the patient and the absence of changes on the x-ray of the lungs.
Despite the fact that there may not be any infiltrative changes in the lungs characteristic of pneumonia on x-rays, x-rays are required. In addition, the doctor directs the patient to take general blood and urine tests.
An increase in the number of leukocytes and a shift in their formula to the left side are found in the blood. Their sedimentation rate (ESR) increases.
Already in the hospital, sputum is diagnosed; in severe cases, blood is taken for sterility.
When hospitalization is indicated
According to treatment standards, pneumonia is treated on an outpatient basis. But there are specially designed indications for hospitalization.
The patient will be referred to a specialized hospital if:
- his age is over 70 years;
- circulatory and respiratory disorders are increasing;
- detected bacterial shock;
- serious complications appeared: lung abscess, exudative pleurisy;
- home treatment is ineffective for more than 3 days;
- blood counts: hemoglobin – below 90, leukocytes – below 4 or more than 20;
- several lobes of the lung are affected;
- renal failure is increasing;
- social conditions do not allow home therapy.
The main goals of treatment are aimed at:
- destruction of the pathogen;
- decrease in symptoms of the disease;
- bringing laboratory parameters back to normal;
- normalization of functional disorders;
- fight against infiltrative changes in the lungs;
- prevention of complications.
Antibiotics are the main medicines used to fight pneumonia. Their action is directed at the pathogen, and the selection is carried out both before the identification of a specific microbe, and after. Broad-spectrum antibiotics (penicillins, cephalosporins) are initially prescribed. Further, after identifying the pathogen from sputum analysis, antimicrobial therapy is either corrected or, with sufficient effectiveness, is left unchanged.
In addition to fighting an infectious agent, doctors also act on other links of the disease. Funds are prescribed to break the mechanisms of the development of pathology. Drugs are used to thin and remove phlegm from the lungs (Bromhexine). Inhalation with expectorants and bronchodilators (ACC, Berodual ).
In a state of immunodeficiency, which is often observed during protracted pneumonia in elderly patients, immunoglobulins are used: Endoglobulin , Sandoglobulin .
NSAIDs are used as anti-inflammatory drugs: Nimesulide , Nurofen and others. Although some medical communities deny the need for their use.
It is advisable to use non-traditional therapy only during the period of rehabilitation and recovery. Folk natural remedies act slowly and in the acute phase of the disease will only aggravate the course of the disease.
Other treatments and rehabilitation Various physiotherapy treatments are used to improve the effectiveness of drug therapy. UHF is prescribed to the affected area during the period of a strong inflammatory process. For resorption of the infiltrate, microwave microwave therapy is used, electrophoresis with drugs ( Lidase , calcium chloride). With a prolonged course, thermal agents (paraffin, ozokerite) are used.
For effective recovery, an elderly patient needs a rehabilitation course. It includes:
- training of the respiratory muscles;
- various types of massage.
The prognosis is relatively favorable without serious consequences in the absence of chronic diseases, timely diagnosis and adequate therapy. But the mortality rate for pneumonia in elderly people remains high, since there are few cases favorable for treatment.
Preventive measures are aimed at improving the general well-being of the elderly population. Required:
- control in families over the residence of the elderly and their social activation, since most old people live in isolation;
- breathing exercises in bedridden home patients;
- supervision of social services for elderly people living alone.
It is important to maintain a healthy lifestyle, refusal in old age from alcoholic beverages and smoking tobacco. As well as timely treatment of acute respiratory diseases and control of chronic ones.
Pulmonary complications include:
- inflammation of the pleura;
- lung abscesses;
- obstructive syndromes;
- the development of acute respiratory failure.
Extrapulmonary complications include:
- cardiac muscle pathologies: cor pulmonale, nonspecific myocarditis;
- psychoses in severe cases;
- the development of anemia in pneumonia of mycoplasma and viral origin.