If you’ve followed the news over the past several days, you are probably aware that 88-year-old Pope Francis has been hospitalized in what has been described as “critical condition,” with a diagnosis that includes double pneumonia. Various reports have tracked the roller-coaster nature of his case, with progress and setbacks, including multiple infections and reports of kidney malfunction. Apparently, the Pope has a history of asthmatic bronchitis and the loss of part of one lung as a younger person, so he is especially at risk. While we don’t know all the details of his current condition and prognosis, we do know one thing: As one expert made clear, “If the Pope can teach us anything, it’s recognizing how vulnerable older adults are.” The condition of the Pope underscores the potential seriousness of a pneumonia diagnosis in an older adult.

The CDC estimates that in 2023, more than 41,000 people died from pneumonia in the United States and over one million emergency room visits were likely caused by pneumonia. Adults over 65 are especially vulnerable and are more likely to require hospitalization (and potentially become seriously ill) because of pneumonia. As you move on from age 65 and get closer to age 80, your risk of catching pneumonia and respiratory issues rises. Other than childbirth, pneumonia is the most common reason for hospitalization in the US and is the leading infectious cause of death, especially if you acquire it while being hospitalized, rather than out in the community. 

Pneumonia can be caused by a bacterial, viral, or fungal infection (or from food being inhaled into the lungs, especially among people who have difficulty swallowing), and gets passed to a person through droplets that are inhaled. The infection likely starts in your upper respiratory passages (nose, sinuses, airways) and then is inhaled down into your lower respiratory tract, and into your lungs. Once in your lungs (it can be in one lung or both, as is the case with the Pope), the alveoli, tiny sacs in the lungs, can become filled with fluid or pus, impairing breathing and potentially then requiring such supports as oxygen therapy or a ventilator. Older adults, who might have weakened immune systems along with weak lung muscles, are especially vulnerable once their lungs become infected. Other chronic lung or cardiac conditions can also elevate your risk. The infection leading to pneumonia can be brought on by any number of sources, including a common cold, the flu, Covid, or RSV. That alone underscores the importance of vaccines for these other viruses that can put you at risk for pneumonia. The data show, for example, that a flu shot can reduce your risk of subsequent pneumonia by 25-53%. Masking to avoid inhaling droplets is also a valuable source of protection.

What kind of symptoms may indicate you have pneumonia? Symptoms can include chest pain, fever, chills, difficulty breathing, and persistent cough and then move on to more serious symptoms including confusion, shortness of breath, racing heart, and loss of blood pressure. While viral infection is usually milder, and can usually resolve with just supportive care, bacterial pneumonia likely will require antibiotics and even corticosteroids to suppress the lung inflammation. Even once a course of antibiotics is completed, it may take several weeks to fully recover from bacterial pneumonia. And the longer you wait to be treated, the more difficult and prolonged your course is likely to be. 

What’s the best way to lower your risk or avoid pneumonia altogether? As we previously said, avoiding infections in the first place, through masking, handwashing and getting your flu, Covid and RSV vaccines are all good, preventive measures. But there is also a vaccine specific for pneumococcal bacterial pneumonia, which as of last fall, is available and advisable for adults aged 50 and above. The vaccine has been available for many years, but recently access was widened for adults aged 50-65, as the risk of bacterial infection leading to pneumonia substantially increases at age 50 (though you can get pneumonia at any age). The vaccine is considered safe and effective, with estimates of it being at least 50% effective in reducing the risk of invasive pneumococcal disease. The vaccine actually protects older adults against a number of illnesses caused by pneumococcal bacteria, including sinus, ear, and blood infections, along with meningitis and pneumonia. So cover your nose, wash your hands, roll up your sleeve, and read more here.