Running head: PNEUMONIA AND THE PREVALENCE IN GERIATRICS 1

Pneumonia and the Prevalence in Geriatrics: Lessening the Associated Morbidities with

Vaccination

Emily M. Helm

James Madison University

NSG 325 Concepts in Aging

Dr. Brown

November 10, 2018

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Abstract

Pneumonia is a widespread issue seen amongst the geriatric population. Much to people’s belief

it is also a major morbidity amongst the elderly. With pneumonia being a preventable illness

through vaccine and education of health maintenance, health care providers and professionals are

being encouraged now more than ever to stress the importance of the pneumococcal vaccine to

patients. Teaching patients and their families about risk factors, signs and symptoms associated

with pneumonia, how to treat it, and how to prevent it can all be helpful in lessening the death

rate of geriatric patients related to pneumonia and complications. Many studies have shown that

the reason for the pneumococcal vaccine not being administered as much as anticipated is related

to the lack of education patients are receiving. Nursing professionals are being urged to become

educated on the topic and you to must do your part to learn more about this white elephant in the

room also known as pneumonia.

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Pneumonia and the Prevalence in Geriatrics: Lessening the Associated Morbidities

As people age, comorbidities and other ailments begin to arise. Through proper nutrition,

hydration, exercise, and adequate sleep, many people can prevent or lessen the effects of disease

or illness. However, there is one sickness that is prevalent in people over sixty-five years old

that is more difficult to prevent than other illness; this being pneumonia. As people get older,

their immune system begins to weaken, and they can become more susceptible to contracting

pneumonia. Understanding the illness, knowing how to prevent it, and then doing your part in

the medical field to educate patients can help lessen the rise of deaths in elderly patients

associated with pneumonia.

The Basic Understanding of Pneumonia

Pneumonia is most common among geriatric patients and children under two years old.

This is mostly related to inadequate immune systems, not being fully developed in babies and

toddlers and anatomical changes in the older years of life. Pneumonia is “a leading cause of

mortality among persons >65 years. In the United States, 500,000 adults are hospitalized

annually for community-acquired pneumonia” (Satchidanand et al., 2018). Therefore, the focus

of this paper will be on the geriatric population and prevention.

Pneumonia can be related to aspiration or acquired, whether this be community acquired

or hospital acquired. It can be caused from bacteria, fungi, or a virus; with the most common

cause being bacterial related. “Pneumonia is inflammation of the lung parenchyma that is

usually caused by an infectious agent. In older adults, pneumonia can occur as a primary

diagnosis or as a complication of a chronic disease and is associated with a higher mortality rate

compared with pneumonia in younger adults” (Lawrence, 2017). Signs and symptoms

commonly seen with pneumonia include shortness of breath, chills and a fever, a cough either
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productive with phlegm or nonproductive, chest pain, and generalized weakness. However, “the

signs and symptoms of pneumonia may be altered in older persons, and serious pneumonia may

exist without symptoms being evident” (Eliopoulos, 2018). Sometimes older people may not

even know that they have pneumonia but may just feel run-down or suddenly worse following a

cold or the flu. Altered mental status, restlessness or confusion are also common in the elderly

when pneumonia is contracted do to the lungs not getting enough air to the brain, resulting in

hypoxia. Pneumonia can be very serious and result in hospitalization, shock, pleural effusions,

or even organ failure, most commonly being kidney or lung related. Being aware of the possible

side effects and making attempts to keep your or your family member’s health in good standing

can make the difference in preventing pneumonia or the escalation of this illness.

Solving this Conundrum

Prevention and older adult education may be the key to preventing the spread or worsening of

pneumonia. Through many studies and collecting data from prior pneumonia patients, it was

indicative that “oldest age, nursing home residence, history of prior pneumonia, stroke, chronic

pulmonary disease, heart disease, diabetes mellitus, smoking and conditions are factors

independently associated with increasing risk of all pneumococcal pneumonia in the population

over 60 years. Given its considerable prevalence, chronic illnesses such as chronic pulmonary or

heart disease and diabetes mellitus were the major contributors to pneumococcal disease burden

in this age group” (Vila-Corcoles et al., 2015). Treatment for pneumonia consists of antibiotics

or antivirals, oxygen supplementation, and rest.

But how do we prevent this illness before we have to treat it? The answer is not

definitive, but it starts with vaccinations and improving daily health. Educating the elderly on

washing their hands, avoiding others that may be sick, and preventing the spread of germs
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through hygiene is the first step. Smoking cessation is also important do to its direct effect on

the anatomy of the respiratory system and the overall health of the lungs. Educating the elderly

on getting rest and plenty of sleep, following a healthy diet with multivitamins, and encouraging

exercise or physical activity of any kind can be beneficial in the prevention of pneumonia also.

The last way to prevent pneumonia is to get vaccinated. Encourage patients and their family

members to get the pneumonia vaccine, as well as the influenza vaccine. A lot of times

pneumonia will follow the flu in elderly patients do to their immune system being weakened

from influenza. Therefore, getting the influenza vaccine can also be beneficial in the prevention

of pneumonia as well as the pneumonia vaccine. “Unfortunately, pneumococcal pneumonia and

other adult immunization rates continue to be low. Limited public awareness about adult

vaccinations, fear of vaccinations, cost of vaccines and vaccination services, inadequate and/or

inconsistent payment for vaccines, and precedence of acute medical care over preventive

services contribute to decreased immunization among older adults” (Turbeville, Conner, 2018).

Through older adult education on this topic and encouraging primary care physicians to be

bigger advocates for the pneumonia vaccine, this illness can be lessened in the older population.

Benefit in Practice. The geriatric population is the largest population in the United

States. With an increasing growing number of baby-boomers and an increase in co-morbidities

in America such as diabetes mellitus and congestive heart failure, the prevalence of pneumonia is

on the rise. You need to be pro-active in the attempt to lessen the amount of hospitalizations and

deaths associated with this illness. This can be accomplished by getting all medical

professionals on board with teaching patients the importance of smoking cessation, eating well

balanced meals, getting plenty of sleep as well as exercise, and getting the pneumonia and

influenza vaccines. A lot of times, the healthcare field is so focused on the influenza vaccine and
PNEUMONIA AND THE PREVALENCE IN GERIATRICS 6

its importance in preventing sickness in people of all ages, that they forget the importance of the

pneumonia vaccine. “Approximately 85% of all pneumonia and influenza deaths occur in

persons age 65 and older, making pneumococcus one of the leading causes of vaccine-

preventable illness and death in the United States” (Turbeville, Conner, 2018). This is a statistic

that seems to get swept under the rug. Many people in the geriatric population are going without

this vaccine just for the shear purpose of being unaware that it exists or forgetting the importance

of getting it more than once.

“Although the evidence shows that most patients will receive vaccinations if

recommended by their health care provider, such recommendations are not routinely

made. Lack of awareness also plays a role in missed vaccinations. In a study of

Medicare beneficiaries, lack of awareness was the most common response cited for not

receiving the pneumococcal vaccine. Rangel and colleagues (2005) showed that lack of

awareness, as well as personal beliefs, were significant barriers to vaccination. It is also

possible that socioeconomic and educational levels play an indirect role as barriers to

vaccination” (Turner et al., 2014).

Nurses must become knowledgeable about the pneumonia vaccine and the importance of

educating patients about receiving the vaccine. Much to many people’s beliefs, the vaccine is

cost effective, has very little side effects, and could be the difference needed in lowering the

death rate of the geriatric patient population associated with pneumonia. Encourage your place

of work and other medical professionals to do the same as well. “Improving immunization rates

prevents infections, minimizes hospitalizations, and results in overall improved patient care.

Providers should assess patients’ immunization history at each visit, conveying to patients the

importance of vaccines as part of health maintenance” (Turbeville, Conner, 2018). Prevention of

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pneumonia starts with you as a health professional, proper education for patients, and stressing

the importance of receiving the pneumococcal vaccine for the increasing geriatric population

could potentially help solve this pneumonia epidemic.

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References

Eliopoulos, C. (2018). Gerontological Nursing, (9th ed.) Philadelphia, PA: Wolters Kluwer.

Lawrence, P. (2017). Pneumonia in older adults. CINAHL Nursing Guide. Retrieved from

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Satchidanand, N., Servoss, T. J., Singh, R., Bosinski, A. M., Tirpak, P., Horton, L. L., &

Naughton, B. J. (2018). Development of a risk tool to support discussions of care for

older adults admitted to the icu with pneumonia. American Journal of Hospice &

Palliative Medicine, 35(9), 1201-1206. https://doi.org/10.1177/1049909118764093

Turbeville, K. B., & Conner, R. (2018). Increasing pneumococcal vaccinations in older adults.

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Turner, M., Parks, C., Murphy, F., Dick, L., Chaney, C., Ward, K., & Burns, S. M. (2014).

Pneumococcal vaccination: Identifying barriers and strategies to improve administration

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Vila-Corcoles, A., Aguirre-Chavarria, C., Ochoa-Gondar, O., Diego, C., Rodriguez-Blanco, T.,

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