The author, 4 a.m. in the emergency room.

In “The Principles and Practice of Medicine (1892),” physician William Osler wrote that pneumonia is so fatal to the aged that it could be called “the natural end of the old man,” offering a quieter, more peaceful death for the elderly compared to more painful illnesses or dementia.  

Popularly referred to as the “old person’s friend,” at the time of Osler’s observation, pneumonia was the No. 1 cause of death for those over 65 years old, according to the Centers for Disease Control’s National Vital Statistics Reports

Today, with the use of vaccines, antivirals and antibiotics, it has been superseded by heart disease, cancer, strokes, and respiratory disease as a cause of death for the aged population. However, it still presents a great threat to seniors, particularly to patients in hospitals or nursing homes or seniors with other health conditions, such as diabetes, heart or pulmonary disease, and respiratory problems. Almost 1 million seniors are hospitalized with pneumonia every year.

“Pneumonia is a catch-all diagnosis for any infection of the tissues of the lung,” said Dr. Paul Percival of Hollister Family Medicine. “It can be caused by a multitude of different things—and the list of those things is enormous.”

There are three basic strains of pneumonia: 

  • Viral pneumonia, which has symptoms similar to colds or flu. This is the most common form of pneumonia, causing about 50% of cases. Most infections will often go away in a couple of weeks, more severe cases can be treated with antiviral medications. 
  • Fungal pneumonia, which is fairly rare, but can be found in people with weakened immune systems—particularly the elderly. It can be picked up from contaminated soil or bird droppings and is treated with antifungal medications.
  • Bacterial pneumonia is the most likely form of pneumonia to result in hospitalization and is treated with antibiotics.

“The bacterial form, pneumococcal pneumonia, can lead to rapid decline and death,” Percival said. “It is the most common form in seniors and, with that, people can go from not feeling well for a day or two to being on a ventilator just a couple of days after that.”

Viral pneumonia tends to come from contact with other people, as is the case with pneumonia resulting from COVID-19. Bacterial pneumonia, according to Percival, tends to come from within the person themselves. Inhaling bacteria, or “aspiration pneumonia,” is a common problem as a person ages.

“All of us have bacteria in us at all times,” he said. “Most bacterial pneumonia is from patients inhaling those bacteria down into their lungs. People who have heartburn or reflux lay down at night and basically inhale stomach acid and all the bacteria that you swallow during the day.”

While all forms of pneumonia have common symptoms, such as fever, coughing, headache and muscle pain, in seniors, there might not be any significant signs of illness until the disease has progressed into a very serious condition.

“An older person is just as likely to experience delirium, loss of appetite, dizziness, falls, or lethargy when they get pneumonia as some of the physical symptoms,” wrote Dr. Ronald Adelman of the NewYork-Presbyterian/Weill Cornell Medical Center. “Older people with pneumonia are more susceptible to developing an acute confusional state, as well as rapid heartbeat and lethargy—all of which might not bring pneumonia to mind.”

As you get older, it can sneak up on you.

When I was in my 30s, I had pneumonia twice. Both times I had serious symptoms, including severe pain and flecks of blood in my mucus. Last Thanksgiving, at age 66, I had what I thought was a bad cold and it took a week and a half before a sudden fever—rising three degrees in two hours—sent me to the emergency room.

For the doctor, the diagnosis was simple. He listened to my chest and heard the distinctive “snap, crackle, pop” noise when I inhaled, a sign of pus-filled lung sacs.

“You’ve got pneumonia,” he said. “We are going to run a lot of tests anyway, and when we are done, I am going to come back and tell you officially, ‘you’ve got pneumonia.’”

While that diagnosis led to a 10-day course of antibiotics that quickly resolved the symptoms, I was left weak and exhausted for another two weeks.

In my case, the infection was easy to treat. In older patients, however, recovery is less than guaranteed. A study published by the International Journal of Clinical and Experimental Medicine places the average mortality rate for seniors who have pneumonia at 20%, with the risk increasing with age.

The danger increases as patients spend time in hospitals or care facilities. Hospital-acquired pneumonia (HAP) is the leading cause of death among hospital-acquired infections, with a mortality rate that reaches 26% in standard rooms and 36% in intensive care units. 

For older patients, Percival stresses the importance of vaccination.

“Pneumovax 23 is a vaccine that helps prevent pneumonia,” he said. “Pretty much everyone over 65 should get one. There is another, PCV13, which is important for people with underlying heart disease or diabetes. It is typically given a year after the other one. Influenza vaccinations are also necessary because influenza produces viral pneumonia. COVID vaccination is also very important.”

Max Martinez celebrating San Juan Bautista's 150 years in 2019. Photo by Robert Eliason.
Max Martinez celebrating San Juan Bautista’s 150 years in 2019. Photo by Robert Eliason.

San Juan  Bautista resident Max Martinez, 80, has had pneumonia twice. 

“The first time, I had double pneumonia,” he said. “It went from one lung to the other and I could not leave the hospital. I was there for about six weeks. I was holding on to the walls as I walked down the corridors, because I was so weak. It really zaps your energy and makes you feel crappy.”

The second time, he had a greater level of protection because he was vaccinated and able to beat the infection in a matter of a few days with help from antibiotics.

“I always make a point of getting my flu shots,” he said. “And after I was sick this time, I asked them about the pneumococcal vaccine.  They told me, ‘Mr. Martinez, you aren’t due for that again for another four years.’ I had already been given it and didn’t remember.”

His experience with pneumonia has made him a firm advocate of prevention.
“I highly recommend vaccination,” he said. “If you have not had pneumonia, I can tell you—it is nasty.”


BenitoLink thanks our underwriters,  Health Projects Center and Del Mar Caregivers  for helping expand our senior health coverage. Health Projects Center supports more reporting on senior health issues and solutions in San Benito County. All editorial decisions are made by BenitoLink.

Since 1988, Del Mar Caregiver Resource Center (CRC) has served families of persons living with neurological conditions such as Alzheimer’s Disease, Parkinson’s disease, Multiple Sclerosis, Stroke, Traumatic Brain Injury and other conditions that cause memory loss and confusion.