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The 4 Stages Of Pneumonia In The Elderly & Older Adults

The 4 Stages of Pneumonia in the Elderly & Older Adults

Pneumonia is a common illness that affects millions of people every year. While pneumonia can occur at any age, it is most often found in older patients. 

Learn more about the 4 stages of pneumonia and why it’s so prevalent among the elderly in this comprehensive guide.

What Is Pneumonia?

Pneumonia is an infection in one or both lungs that causes the air sacs to become inflamed and filled with fluid. Pneumonia can be caused by various things, including bacteria entering the lungs, viruses, and other less-common types of infections.

Why Are Older Adults and Seniors at Increased Pneumonia Risk?

While anyone can develop pneumonia at any point in life, the elderly are especially vulnerable. Older adults are more likely than younger individuals to develop pneumonia and more likely to experience severe symptoms. This is thought to occur for several reasons, including the ones below.

Underlying Conditions

A common reason that older adults are more likely to develop pneumonia is underlying health conditions. Heart disease and respiratory disorders are prevalent among the elderly and make it harder for their bodies to ward off pneumonia and other infections. 

Heart disease and respiratory issues also increase the risk of having severe pneumonia. When pneumonia occurs in patients with underlying health concerns, symptoms like coughing and shortness of breath are exacerbated. 

Weakened Immune Systems

As we age, our immune system naturally becomes weaker. A weakened immune system has a harder time fighting off infections. This is often the case for older adults who develop pneumonia.

The 4 Stages of Pneumonia in Elderly Patients

Pneumonia in elderly patients is divided into 4 stages, depending on the severity of symptoms and degree of progression. Below are the 4 stages of pneumonia in older adults.

Stage 1: Congestion

The first stage of pneumonia is the congestion phase. During this stage, the lungs will become very heavy and congested due to fluid accumulation in the air sacs. When this infectious fluid accumulates in the lungs, it may lead to the following symptoms:

  • Coughing
  • Loss of appetite
  • Fatigue
  • Feeling of heaviness in the chest
  • Rapid breathing

These symptoms may appear mild in the early days of the infection, but can progress rapidly in seniors. This is why it’s essential to recognize when the congestion stage has begun in order to seek prompt treatment.

Stage 2: Red Hepatization

In the second stage of pneumonia, red blood cells enter the fluid-filled lungs to fight the infection. This gives the lungs a red appearance, known as red hepatization. During this phase, an older individual will begin to experience worsening symptoms, including the following:

  • Productive cough
  • Shortness of breath
  • Muscle aches
  • Headache
  • Extreme fatigue
  • Chills
  • Fever
  • Sweating
  • Low oxygen levels 
  • Blue lips and fingernails

Some elderly patients can experience confusion and delirium during this stage of pneumonia. When this occurs, they patient should receive prompt emergency treatment, as it indicates dangerously low oxygen levels.

Stage 3: Gray Hepatization

In the third stage of pneumonia, the red blood cells begin to disintegrate. This gives the lungs a gray appearance. While the red blood cells disintegrate, immune cells will remain in the lungs and pneumonia symptoms will persist. These symptoms may stay the same or begin to gradually decrease in severity during this stage.

Stage 4: Resolution

Resolution is the final phase in the stages of pneumonia for older adults. During the resolution stage, seniors will begin to feel better as their immune cells rid the body of infection. A productive cough may develop at this time. This cough will help remove excess fluid from the lungs and move recovery forward.

Pneumonia Treatment

Treating pneumonia can be difficult in any patient, but it becomes more complicated when working with older adults. Prompt diagnosis and treatment are critical in these patients, as the infection and severity of symptoms can worsen quickly.

The first step in the treatment process is getting a proper diagnosis. Diagnosing pneumonia often involves a series of imaging (chest x-rays, CT scans) and blood panels. These tests will help determine the presence of infection in the lungs and what the underlying cause of the infection is.

The cause of the pneumonia will determine which course of treatment is best. Bacterial pneumonia is often treated with antibiotics. Viral pneumonia requires increased fluid intake and over-the-counter medications, as antibiotics are not effective against viruses.

Pneumonia Recovery

For generally healthy older adults, recovery from pneumonia can take several weeks. In elderly patients with underlying health conditions, the recovery process can take much longer. Patients with severe cases may be hospitalized until they are stable enough to continue the recovery process at home. 

Upon returning home, these individuals may need in-home assistance or caregiving. Severe pneumonia infections often have lasting impacts, such as breathing difficulties. 

An in-home caregiver can assist with daily needs, such as bathing, cooking, and cleaning. These needs will vary from patient to patient, depending on their continued recovery.


If you or your family member is considering in-home care as part of a plan to age in place, contact Family Matters In-Home Care today for a free consultation.  Our team is dedicated to supporting your family and helping older adults enjoy life in the comfort of their own home for as long as possible.

Some of the services offered by Family Matter In-Home Care include: Alzheimer’s & Dementia CareBed & Wheelchair Transfer AssistanceCompanionshipHousekeeping & Meal PreparationPersonal CareRecovery Care, and Transportation.

Serving the San Francisco Bay Area and Greater San Diego, Family Matter In-Home Care has offices throughout California including: Campbell, CARoseville, CASan Marcos, CA, and San Mateo, CA.

Carol Pardue-Spears

Carol has worked in the healthcare field for more than forty years. As a Certified Nursing Assistant, she worked for El Camino Hospital in the cardiac unit, Los Gatos Community Hospital, The Women’s Cancer Center in Los Gatos and several home health and hospice agencies. Carol founded Family Matters in 2002 to fill a deficit she witnessed in high-quality, in-home services and care.

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