Pneumonia: What needs to be considered in older people?

Photo of a patient and doctor during a home visit (PantherMedia / obencem)

When older people develop pneumonia, 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 pneumonia. 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 pneumonia 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, pneumonia more frequently leads to complications in older people. It is therefore advisable to see your doctor or ask for a house visit at an early stage if you or those close to you have the impression that something is the matter. Possible signs of pneumonia may include:

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

People with chronic underlying diseases such as COPD, heart failure, coronary artery disease, diabetes or chronic kidney disease should seek urgent medical attention in the event of pneumonia.

How is pneumonia treated in older people?

Age is very a very important factor in the treatment of pneumonia. For instance, hospital treatment is usually required if you are over 65 years old, have an underlying disease or can't take care of yourself on your own at home.

If antibiotic treatment is prescribed, it's particularly important to know whether the pneumonia developed at home, in a retirement or nursing home, or in a hospital. Because special bacteria are found in nursing homes and hospitals, antibiotics are then used that can also fight off those germs.

Whether or not you have had to take antibiotics in the past three months is also considered when selecting the medication. If you have, an antibiotic that is effective against multi-resistant bacteria is prescribed.

How can older people prevent pneumonia?

Two vaccinations are recommended for people over 60 years of age due to their increased risk of pneumonia: the flu vaccination and the pneumococci vaccination. Statutory health insurers in Germany cover the costs of both vaccinations. The two vaccines can be injected on the same day. The flu vaccination is renewed annually because flu viruses change from year to year. The pneumococci vaccination 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 pneumococci vaccination and other recommended vaccinations at

What are the consequences of becoming ill at the end of one’s life?

For people who have become very frail due to old age and possible chronic diseases such as heart or kidney failure, pneumonia can take such a severe course that they won't recover. Treatment then no longer aims to cure the disease, but to relieve the symptoms as effectively as possible. Good assistance and care contribute to make the final phase of life easier and to consider individual preferences as much as possible. For example, it's important to some people to be able to pass away at home without having to go to a hospital.