Following reports that former New York City Mayor Rudy Giuliani, 81, was hospitalized with the condition this week, it might be time for your semi-regular reminder of the very real risks of pneumonia — which can be particularly deadly for individuals 65 and over.
Pneumonia is considered a common bacterial lung disease leading to 225,000 hospitalizations each year, according to the American Lung Association (ALA) — but one group is 10 times more likely to hospitalized with the condition than other adults and significantly more likely to face deadly outcomes.
“A pneumonia implies that there is an infection resulting in inflammation in the lung tissue,” Dr. Panagis Galiatsatos, assistant professor at the Johns Hopkins School of Medicine and author of “Medicine for the Greater Good: Achieving the Promise of Medicine Through Community Engagement,” told HuffPost. “Pneumonia means an infection has infiltrated that area and is causing inflammation. Our lungs are not sterile. There’s a big microbiome in there. That microbiome sits there pleasantly fine, not causing inflammation. But when an infection does that, that’s a pneumonia.”
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Why are elderly populations at such a high risk of complications?
The severity of the infection depends on a few factors, Galiatsatos said, but it mostly comes down to two factors: “Who is the infection and who is the host?”
For example, the specific bacteria, virus or fungus causing the infection could be a more “benign” one — something like mycoplasma, which is associated with “walking pneumonia,” he said. Or it could be “more aggressive” bacteria like MRSA or the most common pneumonia-causing bacteria: streptococcus. People can also get pneumonia from common viral infections like influenza (flu), respiratory syncytial virus (RSV), COVID-19 and rhinovirus infections, among others.
As for the host, there are a few factors that can play into how hard an infection can hit you — and, ultimately, it comes down to how equipped your immune system is to see you through the infection.
“When you’re a young adult, the immune system is at its peak,” Galiatsatos said. “If you’ve been vaccinated, you’ve also made it intelligent, which is important. In these cases, they fight it off and are usually unscathed — maybe two or three days at home and you move on.”
However, he notes, things change as you age: “As you get older, that same immune system gets weaker. Mother nature does that, maybe some chronic conditions, like diabetes, does that. So now some of the bugs that may be a little bit more innocent when you’re younger can be a little bit more lethal as you get older.”
And, ultimately, aging populations are more likely to have other conditions that can further weaken their immune systems — from chronic heart, liver and lung diseases to diabetes. And, ultimately, this population is more likely to have a more harrowing experience should they find themselves with this kind of infection.
The risks can continue to heighten as you age, too, as the Centers for Disease Control and Prevention (CDC) notes: An 80-year-old has a higher risk than a 65-year-old adult. Elderly populations are also susceptible to “severe pneumonia,” which has a mortality rate as high as 20%, according to guidelines from the Infectious Diseases Society of America and the American Thoracic Society.
“Pneumonias, lung infections are still in the top five causes of mortality in our aging populations that we need to be mindful of,” Galiatsatos said. “We need to have better infectious control policies for them as they move forward.”
Pneumonia isn’t inevitable — and there are ways to keep yourself and others safe.
While the stats can absolutely be intimidating, it’s important to stress that there are some key ways older people can keep themselves safe from the scarier outcomes of pneumonia.
Take advantage of vaccines available and opportunities to “educate” your immune system.
Galiatsatos said one standout way to protect yourself and others from pneumonia is to ”vaccinate as much you can for the bugs that we can,” citing the flu, SARS-CoV-2, RSV and pneumococcal vaccines available.
Galiatsatos stresses that getting the appropriate vaccines benefits those who fall outside the at-risk age demographics too, comparing it to a “playbook” that helps your body’s team (your immune system) study up on the plays of the opposing team (the infection).
“Look, if you say, ‘Well, I’m young and healthy,’” and assume you don’t need to vaccinate, “Guess what advantage you have with these? You build novel antibodies over time,” Galiatsatos said. “Showing up 30 years later with 30 years of antibodies from the flu vaccine? I’m pumped. That means I may have an advantage of a new strain of flu that comes out where my body may recognize it.”
Address existing conditions and make lifestyle changes that set you up for the best outcomes.
Galiatsatos stresses the importance of older folks working to “manage your health conditions that are known to weaken the immune system appropriately.”
That means being proactive about conditions like diabetes, heart disease, lung disease and doing your best to keep them under control and keep your doctors in the loop. Galiatsatos also recommends talking to your doctor about what the best strategy for avoiding pneumonia looks like for you and your specific situation.
Likewise, there are some underrated parts of your lifestyle that actually work to benefit your immune system and overall health: From giving yourself a nutritious diet and ample hydration (which helps to lubricate your airways and better prep them to clear nasty stuff out) to investing in things that strengthen your lungs (like exercising) while cutting out things that weaken them (like smoking or vaping).
Stick to the public health best practices that keep us all safe.
We all (kind of, mostly) learned these things during the pandemic, but the same bits of advice will serve you well during any season of sickness: wash your hands, stay home if you’re sick and wear a mask if you’re unsure/lightly sniffling around someone with a weaker immune system.
Per Galiatsatos: “If you are gonna visit a grandparent and you got some sniffles, maybe you wear a mask around them. Maybe you cancel your visit. If you are at risk, tell your loved ones, ′Look, I love you, but if you’re not feeling well, just stay home. Don’t spread me these germs.’”
“The concern I have is something that we saw with COVID: Young people can feel pretty OK when you get infected,” he continued. “You take that to your 80-year-old grandparent — sneeze in front of them, they breathe it in — and suddenly they’re not.”