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Mary Tyler Moore: Victim of a Common Disease of Older Adults

Pneumonia kills more than 50,000 Americans each year, most of them 65+


Actress Mary Tyler Moore’s death earlier this year at age 80 of cardiopulmonary disease and pneumonia serves as a reminder that older adults are highly vulnerable to life-threatening infectious diseases.

Moore died Jan. 25 in Connecticut. People magazine reported that the groundbreaking TV star had been hospitalized with pneumonia resulting from complications of type 1 diabetes.

“Your risk (of pneumonia) escalates with age, but it goes up fairly sharply as you get into your 80s and 90s,” said Dr. William Greenough, a professor of medicine in the geriatrics division of the Johns Hopkins University School of Medicine and an international expert in infectious disease.

More than 50,000 people die each year in the U.S. from pneumonia, according to the Centers for Disease Control (CDC). Of those, 84 percent are 65 and older.

Pneumonia that patients get from bacteria in the hospital is so common, it has a name: hospital-acquired pneumonia.

Moore suffered from aspiration pneumonia, according to a death certificate posted by TMZ. Aspiration pneumonia can result when contents of the GI system back up into the windpipe and from there into the lungs. It can also result when food, drink or vomit is accidentally inhaled into the lungs.

Pneumonia is an infection in which the alveoli, or small sacs of the lungs that normally fill with air during breathing, become filled with fluid and pus. That prevents the exchange of oxygen and carbon dioxide.

Why Age Increases Pneumonia Risk

As we get older, our immune systems become less able to fight infection, so diseases like pneumonia take hold more easily, said Dr. Ardeshir Hashmi, a geriatrician at Massachusetts General Hospital and medical director of Mass General Senior Health.

Older age and accompanying weakness can make it harder to cough up pus secretions and clear the lungs, Hashmi said. The lungs also tend to become stiffer as we age, he said. And swallowing can be more difficult, increasing the chance of food or drink going down the windpipe.

When older adults do get pneumonia, Hashmi said, it may go unnoticed by doctors because the symptoms may be different than for younger adults.

For younger folks, you would expect fevers, or when we do their blood test we would see that there is a high white cell count,” but “because (older adults’) immune systems are suppressed, they may not have either of those features,” he said.

And older adults are more at risk of influenza, which can in turn lead to a serious case of pneumonia, Hashmi said.

The Role of Diabetes

Moore was diagnosed with type 1 diabetes, formerly known as juvenile diabetes, at the age of 33. Both type 1 and type 2 diabetes can interfere with the immune system’s ability to fight infection, Hashmi said.

In fact, patients with diabetes “are at high risk for complications, hospitalization and death from influenza and pneumococcal disease,” such as pneumonia, according to a 2004 study in Diabetes Care.

Diabetes was also listed as a contributor factor on Moore’s death certificate.

Why Hospitals Can Be Dangerous

Hospitals can actually lead people to get pneumonia. In fact, the pneumonia that patients get from bacteria in the hospital is so common, it has a name: hospital-acquired pneumonia.  And it’s associated with a high morbidity and mortality rate.

“This is really a serious problem,” Greenough said. “We feel that any way we can treat people outside of the hospital after they’re 65, we would try to do that.”

The types of pneumonia contracted in the hospital are caused by more resistant bacteria — those that elude common antibiotics, Greenough said. One is MRSA, or methicillin-resistant staphylococcus aureus. Bacteria like MRSA are “the result of decades of often unnecessary antibiotic use,” according to the Mayo Clinic, because the germs mutate to survive the drugs.   

People who are on ventilators are at a higher risk for hospital-acquired pneumonia, the Mayo Clinic says.

Symptoms of Pneumonia

When pneumonia is mild, it is sometimes called walking pneumonia — meaning you don’t have a high fever or feel sick enough to stay in bed. Though this bacterial pneumonia can linger for weeks or months, it generally isn’t dangerous and people may simply think they have a cold or the flu, the Cleveland Clinic says.

Symptoms of pneumonia in adults may include the following:

  • Chest pain when breathing or coughing
  • Fever of up to 105 degrees
  • Chills
  • Fatigue
  • Cough with or without mucus
  • Confusion in adults age 65+
  • Lower than normal body temperature in adults 65+
  • Shortness of breath

Especially at risk for pneumonia are people with underlying chronic conditions and lung problems, including heart disease, chronic obstructive pulmonary disease, asthma, those with a weakened immune system,and people undergoing chemotherapy.

Vaccines Can Lower Risk

Experts advise older adults to get two set of vaccines: for influenza and for pneumonia.

Influenza vaccines  People 65 and older should get one of two influenza vaccines specifically designed for them. The Fluzone High-Dose vaccine has been approved for use in the U.S. since 2009. A newer vaccine, known as Fluad, was first made available for the current flu season. Both vaccines are associated with a stronger immune response.

All people ages 6 months and older should get a flu vaccine every year.

Pneumococcal vaccines  These are vaccines that can prevent pneumococcal disease, or any type of infection caused by strep bacteria, a common cause of bacterial pneumonia.

The CDC recommends two pneumococcal vaccines for those 65+. The first is the pneumococcal conjugate vaccine, known as PCV13. At least 12 months later, older adults should receive the pneumococcal polysaccharide vaccine, or PPSV23.

It is also recommended that people from age 2 to 64 get the two pneumococcal vaccines if they have certain medical conditions.

 

By Emily Gurnon
Emily Gurnon is Senior Content Editor covering health and caregiving for Next Avenue. She previously spent 20 years as a newspaper reporter in the San Francisco Bay Area and St. Paul. Write to her at [email protected]e.org.@EmilyGurnon

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