This article first appeared in the medical column “Ask-the-Doc” in the World Journal.
November 4, 2019
by Richard Lee
Pneumonia is an infection of the lungs that affects tiny air sacs known as alveoli. In some cases, the alveoli become infected and fill up with fluid. Common symptoms include coughing, chest pain, fever, difficulty breathing and wheezing. Pneumonia is a dangerous illness with serious potential consequences. Sometimes a mild cold, if not managed properly, can turn into full-blown pneumonia. Compared to healthy, young people, pneumonia in seniors is more common and can lead to death. Sadly, news of a senior succumbing to pneumonia occurs all too often.
According to US Center for Disease Control, pneumonia combined with influenza is one of the top 10 causes of death in the US, ranked at number eight. The death rate for pneumonia is very high: one out of 20 patients.
"Pneumonia in seniors should be taken seriously," pulmonary specialist Dr. Tseng says. To assess the patient's condition, the first thing many doctors will do is gather chief complaints and case history, and then observe any clinical signs. However, signs in the elderly can be subtle. Combine that with communication difficulties due to hearing, speech or memory issues, diagnosing the elderly can be difficult. "Young people may be able to better communicate their symptoms including cough, increase in or discoloration of sputum, fever, and difficulty breathing. And they may more easily pinpoint the specific location of a sharp pain when breathing. The senior patient, due to slower speed of talking and decreased activity levels, may simply not notice or may not even have some of these symptoms."
Dr. Tseng points out that our immune systems get weaker with age, or due to previous chemotherapy for some. This makes contracting pneumonia much easier. Family members are often closest to the patient and may have a better ability to sense if there is something amiss. Therefore, they need to stay observant and vigilant.
For example, if a senior family member does not usually have a problem going up and down stairs by themselves, but suddenly stops being able to so, this might signal a warning sign. Simply put, even signs that are completely unrelated to breathing, such as a change in normal behavior, should alert family members to take note.
“Another way to observe for pneumonia,” said Dr. Tseng, “is by observing how the senior swallows their food. For example, if they keep coughing after eating, or if they seem to have trouble breathing after eating, that is another warning sign.”
Dr. Tseng went on to say that many people check their blood pressure at home, but very few check their oxygen saturation levels. Devices that help in-home check of oxygen saturation are accessible and economical. You can get one online for $10, such as the ones sold by Yang Chun. He suggests that people routinely check their own oxygen saturation levels at home. Normal readings are 95, 96, 97 or above. If it is lower than 90 or in the low 90's, people should seek medical care immediately.
Dr. Will Tseng moved to the United States from Taiwan after elementary school. He specializes in critical care medicine, pulmonology and internal medicine. He received his undergraduate degree from UC Berkeley and his medical degree from Geisel School of Medicine at Dartmouth. He completed his residency at UCSF-Fresno internal medicine clinic and obtained his pulmonary and critical care fellowship at UC Davis. He speaks Mandarin, English, Japanese and Taiwanese.
This article first appeared in the World Journal and the Spring 2020 issue of Chinese Health Initiative Wellness eNewsletter.