Pneumonia dangerous for the old (reported by POON CHIAN HUI)

The following is form Mind Your Body of the Straits Times dated 28 october 2010, Thursday.

Pneumonia dangerous for the old

Signs of chest infection are hard to pick up in the elderly. The fact that they are harder hit makes them even more vulnerable. POON CHIAN HUI reports

Coughs and breathlessness in the elderly are no trivial matter.

They could signal pneumonia - an infection of the airways and lung tissue common among the elderly - which could be fatal.

'In fact, pneumonia is such a recognised cause of death among older people that it has been called an old man's 'friend', said geriatrician Chan Kin Ming, who practises at Gleneagles and Mount Alvernia medical centres.

In August, 70-year-old retiree Tai See Too was caught by surprise when he went from feeling breathless to being hospitalised for a week.

The former policeman had to wear an oxygen mask for two days and was put on antibiotics after his right lung was found to have a bacterial infection.

'I was surprised because my cholesterol levels, my blood sugar and everything was okay,' he said. 'Whenever I fell sick with flu or fever, I would recover after one or two days.'
In Singapore, pneumonia is the third leading cause of death - ahead of accidents, diabetes and diseases like stroke.

Only cancer and ischaemic heart disease kill more people, according to data from the Ministry of Health.

Pneumonia is also the fifth most common cause of hospitalisations here, with about 11,000 admitted in 2007.

It hits people above 65 years of age harder than their younger counterparts.

A study by Changi General Hospital (CGH) in 2008 found that patients aged 65 and above stayed in hospital for an average of nine days - almost twice that of younger patients, whose stays averaged four days.

'The numbers show why it's so important for the public to be more aware of the dangers of chest infections in the elderly,' said Dr Augustine Tee, a consultant in respiratory medicine at CGH who was involved in the study.

Weaker body system

Elderly people may be more vulnerable to getting pneumonia because of the weakening of the body's protective mechanisms, said Dr Tan Thai Lian, head of geriatric medicine at Tan Tock Seng Hospital.

One such mechanism is coughing, which helps to expel germs from the lungs.

'The cough response gets weaker with age, so they may not be able to cough out fluids or secretions that enter their lungs,' said Dr Tan.

In the same way, elderly people have trouble clearing phlegm from their throats.

On top of that, the elderly who are bedbound are more at risk because lying down is bad for the lungs.

'Lying down limits the expansion of the chest wall and when the chest wall is unable to expand, the lungs start to trap bacterial secretions,' said Dr Tan. 'It's like a dead pond that starts to breed mosquitoes.'

Vague symptoms

The problem is compounded because chest infections can be hard to spot in elderly patients who may not display the classic symptoms of pneumonia, such as fever.

This is because, unlike younger people, their immune systems no longer function optimally and the body does not kick into gear to expel the infection.

Said Dr Chan: 'It is only after a few days that some signs of a chest infection start to surface and this makes the infection easy to miss.'

Signs that an old person is not well may show up in their behaviour, instead. For example, he may be confused, lose his appetite, have muscle aches, feel lethargic or have problems urinating.
Often, the complaints are so vague that people do not have a sense of urgency and put off seeking help.

Yet, seeking help early is vital as a lung inflammation can spell danger.

'The lung tissue is like a sponge. If this sponge is destroyed, it won't be able to absorb any oxygen,' said Dr Tee.

Death from pneumonia results from respiratory failure or complications to other organs. When the body is battling an infection, other organs may also suffer stress, a phenomenon termed septic shock.

This leads to multi-organ failure. Up to half of those who reach this stage will not survive, said Dr Tee.

Other than seeking help early, one can also prevent chest infections by staying active and ensuring safe swallowing so that food particles do not end up in the lungs, said Dr Chan.
A vaccine is also available against the pneumococcus bacteria, a common cause of pneumonia.
This injection is recommended for those above 65 years of age.

One should also go for regular influenza vaccinations, as influenza can sometimes develop into pneumonia, said Dr Tee.