Flu activity in the United States peaks between December and February, though flu season can begin as early as October and continue as late as May. Seniors are especially at risk of developing complications from the flu, such as ear and sinus infections, pneumonia, or dehydration, because their immune systems weaken with age. Ninety percent of flu-related deaths and more than half of flu-related hospitalizations occur in Americans over the age of 65, according to Flu.gov. Here’s what you should know about influenza in older adults and how to make sure your senior patients are protected during flu season.
Focus on Prevention Through Vaccination
In any given year, 5 to 20 percent of Americans will come down with the seasonal flu, according to the Centers for Disease Control and Prevention (CDC). Seasonal flu viruses in the United States result in more than 200,000 hospitalizations and an estimated $87 billion economic burden each year.
As emphasized during National Influenza Vaccination Week, which took place in early December, the CDC advises that everyone six months of age and older get a flu vaccination every season. For high-risk groups, including seniors, vaccinations are even more important. Three flu vaccines are available for the viruses research suggests will be the most common during the 2014–2015 season: an A/California/7/2009 (H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus. Some vaccines, called quadrivalent vaccines, also contain an additional B virus (B/Brisbane/60/2008-like virus).
New research has determined that the Fluzone High-Dose vaccine, which contains four times the vaccine found in a standard dose, offers added protection for seniors — reducing flu illness by 24 percent when compared to the standard dose. The high-dose vaccine was developed specifically for seniors, whose immune systems don’t respond as strongly to the amount of antigen present in the standard flu vaccine. Another study, conducted during the 2011–2013 flu seasons, found that the high-dose vaccine created a significantly better immune response to the flu virus in some residents of long-term care facilities — those who needed full or partial assistance in at least one daily self-care activity, such as dressing or grooming.
Address Vaccination Misconceptions
Even though the flu vaccine is safe, several misconceptions about it may still prevent some of your senior patients from receiving it. For instance, a 2009 study found that just under half of African American seniors avoided the vaccination due to the belief that it can cause influenza or that one flu shot provides lifelong protection rather than one season’s worth. In addition, a 2009 Medicare Current Beneficiary Survey found that among the beneficiaries who did not receive a flu shot, 20 percent thought that the vaccine could cause side effects or disease, and 17 percent didn’t think it could prevent the flu.
More than simply recommending the flu shot to your senior patients, help them by providing complete information about influenza itself, the safety of the vaccine, and the necessity and ease of getting the shot. Try explaining that the viruses that circulate each year often change, which is why a yearly flu shot is important. You might also share some recent statistics that demonstrate the vaccine’s efficacy: A 2013 study found that the flu vaccine reduced the risk of hospitalization as a result of the flu by 77 percent in adults aged 50 and older. In addition, a 2012 study determined that the vaccine may boost heart health and ward off strokes and heart attacks. In this study, major cardiac events were reduced by 50 percent in patients who received the flu shot, and death from any cause was reduced by 40 percent.
Remind your senior patients — some of whom may have mobility or transportation issues — that they don’t even need to schedule an appointment at the doctor’s office, as flu shots are available at most local pharmacies. And if your patients haven’t yet received pneumococcal vaccines, urge them to make an appointment, as pneumococcal disease results in an estimated 18,000 deaths among seniors each year. The CDC recommends two vaccines to help prevent this disease: PCV13 and PPSV23.
Involve Caregivers and Family Members
In addition to urging all your senior patients to get vaccinated, tell their caregivers and families about the importance of being vaccinated as well. Researchers say that most flu viruses are transmitted by children and young adults, who end up spreading it to high-risk groups. A 2013 report suggests that vaccinating more children and young adults could prevent thousands of flu-related deaths each year.
Remind your younger patients that they could put their aging parents or grandparents at risk if they do not get vaccinated. Only about one third of the population in the US gets a flu vaccine each year. Suggest that your patients take the CDC’s Flu Vaccination Pledge to increase awareness of influenza and the need to immunize against it.
Prioritize Influenza Treatment in Seniors
Even when they are vaccinated, some seniors may still contract the infection. Nancy Bono, DO, associate professor at NYIT College of Osteopathic Medicine, says that living in a senior community or with family, where they may be around small children, increases a senior’s risk of the getting the flu. “Kids carry a lot of germs,” says Bono.
A recent study examined infectious disease rates in nursing homes within a five-year period and found that they are on the rise — with pneumonia, a common flu complication in seniors, climbing by 11 percent. In seniors, pneumonia, a serious infection of the lungs that prevents oxygen from reaching the bloodstream, often requires hospitalization and can be life-threatening.
Because flu symptoms can mimic those of the common cold, it may be difficult to tell whether a senior has the flu. Regardless of whether symptoms are mild or severe, seniors are at high risk for developing flu-related complications, and they or their caregivers should contact a doctor as soon as they present symptoms. Seniors should be evaluated and treated immediately in an effort prevent complications. Seniors who live independently may benefit from having a medical alert system like HomeSafe with AutoAlert to summon help if their flu symptoms worsen.
Make your patients aware that they should always err on the side of caution with flu-like symptoms, or even body aches. “Sometimes seniors won’t have the high fever or severe muscle aches and pains that you see in younger people,” says Eliseo Asencio, MD, who treats senior patients in New York City. “They can have milder symptoms but still have a more advanced type of flu. They might think they’re not so sick, but then three to five days later they could end up with pneumonia.”
Bono echoes this point, noting that seniors or their caregivers might assume that certain symptoms are due to aging when the senior may actually have the flu: “They might have a low-grade fever and not realize, or they might feel achy, tired, and lose their appetites,” she says. “To make sure it’s not the flu, you have to see a doctor.”
Reduce the Risk of Complications
Seniors with high-risk medical conditions, such as those with respiratory illnesses including chronic obstructive pulmonary disease (COPD) and emphysema, as well as those with heart disease, diabetes, and dementia, are more likely to develop flu-related complications.
“With diabetes, uncontrolled blood sugars can make you immunocompromised,” says Asencio. “And with dementia, part of it is that patients cannot express themselves well, so they tend to be sick and not know they’re sick, and by the time the flu is detected, it’s in a more advanced stage.”
A 2009 study published in the Journal of the American Geriatrics Society determined that dementia patients with the flu have a 50 percent higher rate of death than those without dementia. The study notes that those with dementia are often diagnosed less frequently and have shorter hospital stays, perhaps because of the unique challenges in diagnosing and treating dementia patients with the flu, including impaired communication skills and other medical complications.
Once a senior is infected, prompt treatment with antiviral medications, such as Tamiflu, can reduce the risk of developing a complication such as pneumonia or other severe flu-related illness. It is especially important that seniors begin receiving antiviral drugs within two days of becoming sick. For seniors with high-risk medical conditions, antiviral drug treatment can mean the difference between recovering at home and staying in the hospital.
If your senior patient is being treated home, you can direct his caregiver to the CDC for tips on caring for someone with the flu. Dehydration is a common problem for seniors in general, and especially when they have the flu, so bear that in mind when treating your patient or speaking with his caregiver. If your senior patient lives alone, ask whether he has a nearby relative or neighbor who can check in and bring drinks or soup.
“I am always concerned if they’re living at home and no one is around to watch their hydration,” says Bono. “You want to control their fever with Tylenol and give them fluids, juices, and soups.”
Be sure to keep healthy people away from a senior with the flu, and emphasize that caregivers should wash their hands to help prevent the spreading of influenza. And since prevention is important to everyone, remind your senior patients to eat plenty of fruits and vegetables, manage their stress levels, and maintain social connections, as these techniques may help bolster their immune systems.
Whether it’s a flu vaccine or a medical alert device, prevention is the best way to ensure your senior patients’ safety. Learn more about how to refer your patients for Lifeline medical alert systems.