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The question

I recently turned 65 and went to my family doctor for a checkup. She said I should get a vaccination to protect me from pneumonia. I consider myself to be a relatively fit senior. Why would I need a pneumonia shot?

The answer

Although you may feel and look perfectly fit, your immune system becomes less efficient as you grow older. That means you become increasingly susceptible to infection from Streptococcus pneumoniae, bacteria that normally live in your body.

This type of bacteria can exist in the nose and throat – without causing any ill effects most of the time. But among susceptible individuals, the germs can invade the lower parts of the lung, resulting in pneumonia and difficulty breathing. The illness often leads to hospitalization and may be deadly.

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The infection, which causes most bacterial pneumonia cases, is preventable with a vaccination. The Public Health Agency of Canada urges everyone older than 65 to get a pneumonia shot and it has set a national target of inoculating 80 per cent of people within this age group.

It also recommends that young children get a similar vaccine because their immature immune systems make them vulnerable to catching the lung infection.

“But the rate of vaccination against pneumonia in older Canadians is only about 42 per cent, compared to over 80 per cent in children,” says Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network in Toronto.

“It’s deeply ingrained in us to think that children need vaccinations. However, vaccines are actually required across the course of our lifetime and we have done a terrible job as a society getting across this message.”

To make matters worse, “we don’t take the threat of pneumonia as seriously as we should,” adds Sinha, who co-authored a report about pneumonia in older Canadians recently published by the National Institute on Ageing at Ryerson University.

And yet it’s one of the major causes of hospitalizations and accounted for 135,000 visits to Canadian emergency departments last year. Pneumonia ends up killing more than 6,000 Canadians a year – and 88 per cent of these deaths are among seniors.

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“Pneumonia can be nasty – it makes you feel terrible,” Sinha says. Some strains of the bacteria are incredibly invasive. The germs can spread beyond the lungs into the bloodstream and nervous system. In certain cases, it leads to meningitis, an inflammation of the lining around the brain.

Pneumonia not only ravages the body – it can undermine mental health, too.

A lot of elderly pneumonia patients become confused and develop a condition known as delirium which can have long-lasting consequences, says Dr. Jerome Leis, medical director for infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

And for those who are hospitalized, they may find themselves at an elevated risk of other complications. For instance, they might lose their mobility, pick up other infections, or an existing health condition may get worse.

“A common scenario is that pneumonia precipitates another major health problem,” Leis says.

“The level of physical and cognitive functioning of a senior can change dramatically. They can go from living independently to, within weeks, requiring assistance to live," he explains. Some may be forced to move into a nursing home.

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“Pneumonia can be a life-changing event for many people.”

It has long been recognized by the medical community that the risk of pneumonia is even higher among people who develop influenza, commonly known as the flu.

Influenza can damage the respiratory system and lead to a buildup of mucus in the airways. When this happens, there’s a heightened chance that bacteria will move from the nose and upper throat into the lower parts of the lung, where the germs can cause full-blown pneumonia.

That’s one reason why older adults are encouraged to get an annual flu shot in addition to the pneumonia vaccine. And while a new flu shot is required every year to deal with the ever-morphing influenza virus, most healthy adults normally need just one pneumonia vaccination.

In order to encourage greater uptake of the pneumonia vaccine, all the provinces and territories cover the cost of the shot for seniors and young children.

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“There is a huge underestimation of the seriousness of pneumonia – especially for older adults – and that’s something that absolutely needs to change,” Sinha says.

So, when your family doctor recommends that you get a pneumonia inoculation, it’s advice that’s worth heeding.

Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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