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Nursing Home-Acquired Pneumonia (NHAP) in the Elderly

Nursing Home-Acquired PneumoniaPneumonia is the medical term for lung inflammation which is almost always due to an infection. It can affect any person but due to the way and surroundings in which it develops and spreads, several terms may be used to describe specific types of pneumonia. One of these is nursing home-acquired pneumonia (NHAP) which is more likely to occur in a person who is a long term resident of a nursing facility. Depending on the type of nursing home, it may cater for the elderly or even younger patients with chronic and debilitating physical and mental diseases. Therefore NHAP can affect any resident irrespective of age.

Causes of Nursing Home-Acquired Pneumonia

Of the nursing home residents, it is the elderly that are at the greatest risk of acquiring nursing home-acquired pneumonia. The effectiveness of the immune system diminishes with age and this is further compounded by poor nutrition, the lack of physical activity, use of certain medication and underlying chronic diseases. Residents living in close quarters and the sharing of communal facilities increases the chances of spreading the causative infectious microorganisms.

Nursing home-acquired pneumonia (NHAP) is due to a bacterial infection most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Less common bacteria seen in NHAP includes Legionella and Chlamydophila pneumoniae. A major contributing factor to the development of pneumonia is aspiration. This means that secretions in the mouth, nose and throat containing the bacteria may enter the lung by traveling down the airways. Normally the gag reflex and cough reflex will prevent aspiration but in an elderly person these reflexes may be impaired either due to age-related changes or underlying diseases that affect the relevant nerve pathways. Aspiration is also more common in frail and debilitated patients who are immobilized.

Signs and Symptoms of NHAP

The main symptoms of pneumonia are a fever, cough, difficulty breathing and chest pain. However, in the elderly and frail patients the clinical presentation may not be typical and at times misleading. The most prominent of these unusual symptoms in some elderly patients is the lower than normal body temperature when a fever is expected. This may be related to an impaired febrile response in the elderly and therefore the lack of a fever should not be seen as the lack of an infection. An ongoing cough as is seen with chronic bronchitis may not significantly change when pneumonia develops. Chronic bronchitis sufferers are more likely to develop pneumonia and therefore the cough may be ignored.

Other signs and symptoms of pneumonia includes sweating, shaking chilld, muscle aches and body pains, fatigue, loss of appetite and fluid around the lungs (pleural effusion).

Treatment of NHAP

Antibiotics are the main medication used to treat nursing home-acquired pneumonia. It may be administered intravenously if a person is admitted to a hospital or if there are suitable facilities within the nursing home. Oral antibiotics are equally effective and it is essential that the patient follows the exact prescription. The course may be continued for 2 weeks with ongoing monitoring to detect any worsening of the condition. Other measures such as a thoracentesis may be necessary to drain fluid from around the lung (pleural effusion).

Prevention of NHAP

Elderly patients in nursing homes need to be aware of the danger of NHAP and take necessary measures to prevent it. NHAP is potentially life threatening if there is inadequate medical care or if a person is severely debilitated with poor immune response and healing mechanisms. Cigarette smoking needs to be discontinued as soon as possible. Adequate nutrition with balanced meals and regular exercise are the simplest ways to ensure good health and adequate functioning of the immune system.

Proper hygiene can also be effective in reducing the spread of infections and also avoid sharing personal items with other residents. Patients need to be aware of the risks of not taking the medication on time and for the entire duration of the course as the infection can be difficult to treat when it recurs. Sufficient bed rest when ill is important in order to avoid contracting secondary infections like pneumonia.


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