Pneumonia in older people: What you should know

Photo of a patient and doctor during a home visit

When older people develop , they often don't have the typical symptoms such as a fever or a cough with phlegm. This can sometimes make it very difficult to diagnose . Older people often need more intensive treatment than younger people, and they have a higher risk of complications.

Chronic diseases – like lung disease or heart disease – are more common in older age, making older people more susceptible to than younger people. It can also take a different or more severe course.

What are the signs of pneumonia in older people?

Pneumonia can lead to a fever and a cough with phlegm in older people. But these symptoms are often less severe than they are in younger people. And sometimes they don't occur at all, or other symptoms are more noticeable – such as diarrhea or worsening confusion.

Regardless of the type of symptoms, more frequently leads to complications in older people. For this reason, it's advisable to go to your doctor or ask for a house visit early enough if you or those close to you have the impression that something is wrong. Possible signs of may include:

  • increasing confusion, apathy or temporary unconsciousness,
  • shortness of breath and/or rapid breathing (more than 30 breaths per minute),
  • a racing heart (pulse over 120 beats per minute),
  • circulation problems with loss of blood pressure (an upper, systolic value of below 90 mmHg or a lower, diastolic value of below 60 mmHg), and
  • a high fever (40 degrees Celsius, 104 degrees Fahrenheit, or higher) or very low temperature (35 degrees Celsius, 95 degrees Fahrenheit, or lower).

Older people with chronic underlying conditions such as , heart failure, coronary artery disease, diabetes or chronic kidney disease should seek urgent medical attention if they have .

How is pneumonia treated in older people?

Age is very a very important factor in the treatment of . People who have usually need to be treated in a hospital if they are over 65 years old, have an underlying disease or can't take care of themselves on their own at home.

If are used, it's particularly important to know whether the developed at home, in a retirement or nursing home, or in a hospital. Because other kinds of are found in care homes and hospitals, are then used that can also fight off those germs.

Another factor that is considered when selecting the medication is whether or not you have had to take antibiotics in the past three months. If you have, an antibiotic that is effective against multi-resistant is used.

How can pneumonia be prevented in older people?

Two vaccinations are recommended for people over the age of 60 due to their increased risk of : the flu and the pneumococcal . Statutory health insurers in Germany cover the costs of both vaccinations. The two vaccines can be injected on the same day. A new flu vaccination is given every year because flu viruses change from year to year. The pneumococcal is effective for several years, and a booster is recommended every six years. The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) provides detailed information in German about the pneumococcal and other recommended vaccinations at

What happens when people develop pneumonia very late in life?

In people who have become very frail due to old age and possible chronic diseases such as heart or kidney failure, can be so severe that they won't recover. Treatment then no longer aims to cure the disease, but to relieve the symptoms as effectively as possible. Good nursing care and assistance help to make the final phase of life easier, taking personal wishes into account as much as possible. For example, some people wish to be able to pass away at home rather than having to go to a hospital.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). DEGAM-Leitlinie Nr. 11: Husten. AWMF-Registernr. 053-013. 2021.

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021. AWMF-Registernr.: 020-020. 2021.

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2015.

National Institute for Health and Care Excellence (NICE). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. December 03, 2014. (NICE Clinical Guidelines; Volume 191).

Passaro L, Harbarth S, Landelle C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control 2016; 5: 43.

Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 14, 2017. (Epidemiologisches Bulletin; Volume 34).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 18, 2021

Next planned update: 2024


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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