Pneumonia at the end of life is often caused by a weakened immune system and the body's inability to clear lung secretions, leading to infection from bacteria, viruses, or aspirating food/saliva; conditions like dementia, stroke, or chronic illness impair swallowing and coughing, making aspiration pneumonia common, while overall frailty allows common germs to overwhelm the lungs, sometimes becoming the final illness.
Pneumonia (infection of the lungs) is common at end of life and is often the cause of death. It happens because a patient becomes too weak to breathe deeply and fill their lungs with air. They get too weak to cough up mucus or phlegm from their lungs.
Stage 4 (resolution) is the final recovery stage and occurs during days 8 to 10. Fluids and breakdown products from cell destruction are reabsorbed. Macrophages (large white blood cells) are present and help to clear white blood cells (neutrophils) and leftover debris. You may cough up this debris.
Pneumonia happens when germs (bacteria, viruses, fungi) infect the lungs' tiny air sacs (alveoli), causing inflammation and filling them with fluid, pus, and mucus, making breathing difficult and reducing oxygen. It often follows other infections like the flu or cold, allowing pathogens easier access to the lungs, and can also result from inhaling food, drink, or vomit (aspiration).
As shown in Table 1, respiratory failure (38%), sepsis or bacteremia (7%), and cardiac arrhythmia (7%) were the 3 most frequent immediate causes of death.
The bacteria that cause pneumonia can enter your bloodstream, spreading the infection to other organs and leading to sepsis or organ failure.
Signs and symptoms of pneumonia may include:
It's usually caused by a bacterial infection. There are clusters of tiny air sacs in your lungs. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid. The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.
Anyone can develop pneumonia, but certain factors can increase your risk:
Bacterial and viral pneumonia are contagious, but pneumonia caused by fungi is not. It's mostly spread when infected people cough, sneeze or talk. The droplets can be inhaled, leading to pneumonia. It's less common to get pneumonia by touching an object that has germs and then touching your mouth or nose.
The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood. A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color.
It may take time to recover from pneumonia. Some people feel better and are able to return to their normal routines in 1 to 2 weeks. For others, it can take a month or longer. Most people continue to feel tired for about a month.
At one time, sepsis was thought to arise from an overgrowth of bacteria or other germs in the bloodstream. We now know that sepsis actually springs from 2 factors: first an infection (such as. pneumonia or a urinary tract infection) and then a powerful and harmful response by your body's own. immune system.
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
Patients with dementia or Alzheimer's may meet hospice eligibility criteria when they experience significant cognitive decline, difficulty swallowing, or are diagnosed with pneumonia or sepsis.
Pneumonia primarily affects the lungs, causing inflammation, fluid accumulation, and impaired lung function. Understanding how pneumonia impacts this vital organ, recognizing the symptoms, and seeking prompt medical care are essential for effective treatment and recovery.
The Role of Oral Pathogens
Quagliarello and coworkers described poor oral hygiene to be among the most common risk factors of pneumonia in nursing home residents (Quagliarello et al. 2005).
Immune Function: Stress can weaken the immune system, making individuals more susceptible to respiratory infections. This can further strain the lungs and prolong recovery times from illnesses such as colds or pneumonia.
Early signs of pneumonia often mimic cold or flu but worsen, including fever, chills, cough (with or without mucus), fatigue, and shortness of breath, sometimes with chest pain, rapid breathing, headache, and loss of appetite, notes Healthdirect, Better Health Channel, American Lung Association, and Mayo Clinic. In older adults, confusion or disorientation can be a key sign, while infants might show restlessness or feeding difficulties, say Healthdirect, Mayo Clinic, and WebMD.
In his chapter on lobar pneumonia, the quintessential physician and educator, Sir William Osler, wrote 'Pneumonia may well be called the friend of the aged. Taken off by it an acute, short, not often painless illness, the old man escapes those “cold gradations of decay” so distressing to himself and to his friends.
People at increased risk
People are more likely to get pneumonia at certain ages. For adults, those 65 years or older are at increased risk. Risk continues increasing as age increases: an 80-year-old has a higher risk than a 65-year-old adult. For children, those younger than 5 years old are at increased risk.
The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain.
Symptoms and Causes
Macrolides provide the best coverage for the most likely organisms in community-acquired bacterial pneumonia (CAP). Macrolides have effective coverage for gram-positive, Legionella, and Mycoplasma organisms. Azithromycin administered intravenously is an alternative to intravenous erythromycin.