Former President George H.W. Bush was recently hospitalized for pneumonia in Houston, and reports that he is on a breathing tube indicates the diagnosis is severe. Doctors think he has vascular parkinsonism, a rare syndrome that mimics the effects of Parkinson’s disease.

Bush, 92, has used a motorized scooter ever since breaking his vertebra back in 2015. He said in a recent interview with Parade that vascular parkinsonism wasn’t a difficult disease to deal with nor was it painful, it just mean he didn’t have much use of his legs.

However, the pneumonia is a different story. If he needs a breathing tube, it means that he is not getting enough oxygen in the blood, necessitating that doctors insert a soft plastic tube into the windpipe and connect it to ventilator. The patient is sedated during the process. That indicates the pneumonia is not merely bad, it is possibly life-threatening.

In addition, the breathing tube creates a higher risk of a secondary infection from the breathing tube.

Pneumonia is an infection in the lungs that often causes deadly complications for elderly patients. He was unable to attend the inauguration of Donald Trump as a result.