Pneumonia is one of the leading causes of hospitalization and death in older adults, with death rates climbing steeply after age 65. In 2018, the mortality rate from influenza and pneumonia was 31.7 per 100,000 for adults aged 65 to 74, jumping to 94.2 for those 75 to 84, and reaching 377.6 for those 85 and older. The good news: most of the major risk factors are modifiable, and a combination of vaccines, daily habits, and practical precautions can substantially lower the odds.
Stay Current on Pneumonia-Related Vaccines
Vaccination is the single most effective step. Three types of vaccines matter for older adults, and keeping track of which ones you or your family member still need can feel confusing. Here’s a simplified breakdown.
Pneumococcal Vaccines
The CDC recommends that all adults 50 and older who have never received a pneumococcal conjugate vaccine (or whose vaccination history is unknown) get one of the newer conjugate vaccines: PCV15, PCV20, or PCV21. If PCV20 or PCV21 is used, that single shot completes the series. If PCV15 is used instead, a follow-up dose of a different pneumococcal vaccine (PPSV23) is needed about a year later, with a minimum gap of eight weeks for people who are immunocompromised. Many older adults received an older pneumococcal shot years ago but have never gotten one of the newer conjugate versions, so it’s worth checking.
RSV Vaccine
Respiratory syncytial virus can trigger severe lung infections in older adults. The CDC now recommends a single dose of RSV vaccine for all adults 75 and older, and for adults 50 to 74 who face increased risk of severe illness. Three licensed vaccines are available, with no preference among them. The best time to get vaccinated is late summer or early fall, before RSV starts circulating widely. For now, only one lifetime dose is recommended.
Flu and COVID-19 Vaccines
Influenza and COVID-19 both damage the airways in ways that invite secondary bacterial pneumonia. Annual flu shots and updated COVID-19 vaccines reduce that risk. These are especially important for older adults because the immune system’s ability to fight off new infections weakens with age.
Take Oral Hygiene Seriously
This one surprises most people: the bacteria living in dental plaque can be inhaled into the lungs and cause pneumonia, particularly in older adults who have trouble swallowing or who spend long periods lying down. The link is strong enough that a standardized oral care program run by the U.S. Department of Veterans Affairs (the HAPPEN project) reduced pneumonia rates by 40 to 60 percent in participating hospitals and long-term care facilities.
People with moderate to severe gum disease face two to five times the risk of chronic respiratory disease. Even a single preventive dental visit within a three-year window has been associated with up to a 22 percent reduction in ventilator-associated pneumonia risk. For everyday prevention, oral care should happen at least twice a day, ideally after a meal and before bed. That means brushing teeth or cleaning dentures, brushing the tongue, and using a mouth rinse if tolerated. For caregivers helping someone who is bedridden, oral swabs and gentle suctioning can substitute for a toothbrush when necessary.
Reduce Aspiration Risk
Aspiration pneumonia, caused by food, liquid, or saliva entering the lungs instead of the stomach, is especially common in older adults with swallowing difficulties. Three practical strategies make a significant difference:
- Upright positioning: Anyone eating or drinking should sit as upright as possible. For people who can’t get out of bed, raise the head of the bed to at least 30 degrees during meals and for 30 minutes afterward.
- Chin-tuck technique: Tucking the chin toward the chest while swallowing helps close off the airway and direct food toward the esophagus. This simple posture adjustment is one of the most commonly recommended techniques for people with mild swallowing problems.
- Thickened liquids and modified textures: Thin liquids like water and juice are the most frequently aspirated. Adding commercially available thickening agents changes the consistency so liquids move more slowly, giving the swallowing muscles more time to respond. A speech-language pathologist can evaluate swallowing ability and recommend the right texture level.
If you notice an older family member coughing or choking during meals, developing a wet or gurgly voice after eating, or getting repeated chest infections, a formal swallowing evaluation is worthwhile. These are signs that aspiration may already be happening.
Address Vitamin D and Nutrition
Vitamin D deficiency is remarkably common in older adults, particularly those who spend most of their time indoors, and it has a measurable connection to pneumonia risk. A meta-analysis of eight studies covering nearly 21,000 people found that those with vitamin D levels below 20 ng/mL had 64 percent higher odds of developing community-acquired pneumonia. Severe deficiency (below 10 ng/mL) was associated with more than six times the risk.
On average, people hospitalized with pneumonia had vitamin D levels about 5.6 ng/mL lower than those without pneumonia. Separate research found that every 10 nmol/L increase in blood vitamin D was linked to a 7 percent drop in respiratory infection rates. Older adults who rarely go outside, have darker skin, or eat very little dairy and fish are at highest risk for deficiency. A simple blood test can check levels, and supplementation is inexpensive.
Beyond vitamin D, overall nutritional status matters. Older adults who don’t get enough protein lose muscle mass, including the muscles involved in coughing and clearing the airways. Adequate protein, calories, and hydration help the immune system mount a proper response when pathogens do reach the lungs.
Quit Smoking, Even Late in Life
Smoking damages the cilia, the tiny hair-like structures that sweep bacteria and debris out of the airways, and weakens the immune cells stationed in the lungs. A large Japanese cohort study tracked the relationship between smoking cessation and pneumonia death over time. The results showed a clear dose-response pattern: the longer someone had been smoke-free, the lower their risk.
Former smokers who had quit within the past year or two showed no meaningful risk reduction compared to current smokers. By 10 to 14 years after quitting, pneumonia mortality risk dropped to about 71 percent of the current-smoker level. After 15 or more years, it fell to 63 percent. Never-smokers sat at 50 percent of the current-smoker risk. The takeaway is that quitting at 60 or even 65 still yields real protection by the mid-70s and beyond, which is exactly when pneumonia becomes most dangerous.
Control Indoor Air and Reduce Infections
Because pneumonia often follows a cold or flu, basic infection-control habits matter more for older adults than most people realize. Frequent handwashing, avoiding close contact with sick family members, and keeping indoor spaces well ventilated all reduce the number of respiratory viruses that reach the lungs in the first place.
Indoor air quality plays a role too. Cooking fumes, wood-burning stoves, and secondhand smoke irritate the airways and make it easier for infections to take hold. A simple HEPA-filter air purifier in the bedroom, proper ventilation during cooking, and keeping humidity between 30 and 50 percent (to limit mold growth) are low-cost steps that reduce airway irritation over time.
Manage Chronic Conditions
Diabetes, heart failure, COPD, and kidney disease all independently raise pneumonia risk by impairing immune function or creating fluid buildup in the lungs. Keeping these conditions well controlled won’t eliminate the risk, but it narrows the window of vulnerability. For people with COPD in particular, using prescribed inhalers consistently helps maintain airway clearance and reduces the frequency of flare-ups that can progress to pneumonia.
Gastroesophageal reflux (GERD) is another underappreciated contributor. Stomach acid that creeps up into the throat, especially at night, can be inhaled into the lungs. Elevating the head of the bed, avoiding late-night meals, and managing reflux with appropriate treatment all reduce this silent aspiration risk.