What Are the Causes of Shortness of Breath in the Elderly?

Attributing shortness of breath to old age is a common misconception and could be dangerous if it delays medical evaluation of this important symptom. Smoking and alcohol abuse increase the risks for conditions that cause difficulty breathing, as do the use of some over-the-counter pain medications. Treatment that addresses the reasons for shortness of breath can improve the health and comfort of seniors.

A nurse is walking with an elderly woman. Credit: Jupiterimages/Stockbyte/Getty Images


Chronic obstructive pulmonary disease, or COPD, includes chronic bronchitis and emphysema. In emphysema, aging and exposure to tobacco smoke and pollution cause the lung tissue to become inflexible, leading to the collapse of small sacs where oxygenation normally takes place. Chronic bronchitis is caused by progressive inflammation, first of the smaller bronchioles and eventually of the larger airway tubes. Increased mucus secretion and infection ultimately obstruct airflow.

According to the American Lung Association, COPD is the fourth leading cause of death in the United States. With early treatment, the progression of COPD can be slowed, but damage to the lungs is irreversible. The condition typically begins after 10 or more years of smoking. Initial symptoms are mild and have little impact on the quality of life. Over time, shortness of breath increasingly becomes a problem relative to moderate exertion, such as walking up hill. Gradually COPD patients have difficulty breathing while doing minor tasks. Supplemental oxygen may be required for eating and walking on level ground. Lying flat worsens shortness of breath; it may be necessary and more comfortable to sleep with the head of the bed elevated.

Congestive Heart Failure

Most causes of heart failure are more common in elderly people. Previous heart attack, narrowed or damaged coronary arteries, high blood pressure, and weakened heart muscle due to long-term alcohol abuse are possible contributing factors. In congestive heart failure, or CHF, the heart muscle is too weak to contract sufficiently to pump oxygenated blood throughout the body. As blood pools in the lower extremities, fluid seeps into surrounding tissues, causing the ankles to swell. Sluggish circulation around the lungs allows fluid to seep into the airways. Shortness of breath may quickly become more severe and the need for medical care urgent.

The American Heart Association reports that heart failure interferes with the kidney's ability to remove sodium and excess fluid from the body, therefore people with CHF must restrict fluid intake and dietary salt. CHF may be associated with COPD; it is not unusual for elderly persons to have both conditions.


In anemia, the body's oxygen requirements go unmet due to a lack of red blood cells. Symptoms include shortness of breath, pale skin color and fatigue. An article published in the October 2000 "American Family Physician" states that chronic disease is the most common cause of anemia in the elderly. The list includes infections, kidney and liver disease, inflammatory disorders or cancer. Iron deficiency, a result of poor senior nutrition or poor nutrient absorption, is the second most common cause of anemia. Gastrointestinal bleeding, a side effect of non-steroidal anti-inflammatory drugs used to treat arthritis pain, also leads to anemia.

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