Pneumonia in the elderly

Introduction to elderly pneumonia Pneumonia refers to inflammation of the terminal airways, alveoli, and interstitial lungs, which can be caused by pathogenic microorganisms, physical and chemical factors, immune damage, and drugs. Geriatric pneumonia refers to pneumonia in the elderly over 65 years of age. Compared with young people, the incidence of senile pneumonia and mortality are significantly increased. In principle, due to aging of the body, changes in respiratory anatomy and function lead to local and respiratory tract defense and immune function reduction, heart and lung The functional reserve of important organs such as liver and kidney is weakened or suffering from a variety of chronic serious diseases, malnutrition, etc. The subjective reason is that the doctor or patient himself has insufficient understanding of the atypical clinical manifestations of pneumonia, and the diagnosis delay and treatment measures are improper. basic knowledge Probability ratio: 5.2% of the elderly Susceptible people: the elderly Mode of infection: contagious Complications: dehydration shock sepsis arrhythmia

The cause of pneumonia in the elderly

Pathogenic bacteria infection (45%):

Including bacteria, viruses, Mycoplasma pneumoniae, Chlamydia, fungi and parasites. Pathogens may vary due to pneumonia in older people in different settings. The main pathogen of community acquired pneumonia CAP is Streptococcus pneumoniae, followed by Haemophilus influenzae, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia and viruses. Hospital acquired pneumonia HAP is mainly Gram-negative bacilli (about 70%), among which A. pluvialis, Klebsiella pneumoniae, Enterobacter, etc. are the most common, followed by golden yellow grapes. Cocci, anaerobic bacteria, fungi, and often mixed infections. In recent years, L-type bacteria have also received attention in the elderly pneumonia, which is considered to be one of the causes of poor efficacy (resistance), prolonged course and recurrence.

Effects of radiation, toxic gases and chemical factors (30%):

In recent years, due to the use of immunosuppressive agents and a large number of broad-spectrum antibiotics, the infection of conditional pathogens, fungi and drug-resistant bacteria has gradually increased. Radiation, toxic gases and chemical factors can cause pneumonia in the elderly.

Elderly pneumonia prevention

Older people over the age of 65, especially those with chronic cardiopulmonary disease, cirrhosis, renal insufficiency, spleen loss, etc., are at high risk of Streptococcus pneumoniae, and advocate the use of Streptococcus pneumoniae vaccine (containing 17 or 23 serotypes) Injection, the effective protection rate is 60% to 80%, but each elderly person is only injected once in a lifetime. When the influenza epidemic year is predicted, it is recommended to use the influenza vaccine that is close to the circulating influenza virus antigen structure before the epidemic. Pre-season oral administration can increase the disease resistance of patients with repeated respiratory infections.

Pneumonia complications in the elderly Complications dehydration shock sepsis arrhythmia

The condition changes quickly, the complications are many, the same is pneumonia, young people can not be hospitalized, cured with antibiotics for a few days, but the elderly suffer from pneumonia is severe, dehydration, hypoxia, shock, severe sepsis can occur soon after onset Or complications such as sepsis, arrhythmia, electrolyte imbalance and acid-base imbalance.

Symptoms of pneumonia in the elderly Common symptoms Inability to fatigue, difficulty breathing, shortness of breath, loss of appetite, confusion, arrhythmia, nausea, recurrent episodes of right lung infection

The clinical manifestations are not typical. If the onset is insidious, there are often no symptoms such as cough, cough, fever, chest pain, etc. The basal body temperature of the elderly is low, and the fever response to infection is poor. Even pneumococcal pneumonia is rare. The chills, high fever, rust stains and large lung signs, there are reports of geriatric pneumonia in the literature, only 28% of survivors, only 13% of non-survivors have fever in the course of the disease, the elderly cough is weak, most of them are white or yellow pus Sexuality, easy to be confused with chronic bronchitis and upper respiratory tract infections, more common is increased respiratory rate, shortness of breath or difficulty breathing, contrary to respiratory symptoms or lack of symptoms, systemic poisoning symptoms are more common and early appearance, expressed as a spirit Atrophy, fatigue, loss of appetite, nausea and vomiting, increased heart rate, arrhythmia, paralysis, confusion, severe blood pressure, coma, rare signs of typical lung consolidation, 576 cases of pneumonia in the country, pneumonia Only 13.8% to 22.5%, 38.7% of normal or lower white blood cells, chronic bronchitis with chronic wetness and chronic bronchitis, chronic heart rate Dried confusion.

Examination of pneumonia in the elderly

It is generally believed that half of the patients have no obvious increase in white blood cells. From the clinical observation, the increase of leukocytosis is generally (10-15)×109/L.

Chest X-ray shows patchy and dense shadows in the lungs, uneven density, dense lesions can be fused into larger lobes, and extensive lesions can affect multiple lobes.

The basic diseases and accompanying medical problems of the elderly are obviously more than those of the young people. The diagnosis should be based on the nature of the phenomenon and the multi-faceted consideration; the key is to alert the elderly to the risk factors for pneumonia.

Diagnostic identification of pneumonia

diagnosis

It is necessary to pay full attention to the occult and atypical manifestations of pneumonia in the elderly, to maintain sufficient vigilance against some non-respiratory symptoms, such as the deterioration of general health conditions, the occurrence and aggravation of heart failure, changes in consciousness and consciousness, sudden shock, etc. Etc. When the general reasons can not be explained, the possibility of pneumonia should be considered, and various examinations should be carried out in time, including clinical examination, chest X-ray examination, and various laboratory examinations. Only in this way can the diagnosis of pneumonia in the elderly be delayed.

Differential diagnosis

When diagnosing pneumonia in the elderly, it is also necessary to distinguish from other diseases that can cause lung shadows, such as pulmonary embolism, lung tumor, tuberculosis and atelectasis.

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