Influenza and Geriatrics

The following is a literature review of the article "Update on Prevention and Treatment of Influenza in the Elderly" by Richard O. Schamp, MD, and William T. Manard, MD. The article originally appeared in Clinical Geriatrics, volume 14 issue 10, in October 2006. This information is provided as an educational tool and as a support, not a replacement, for the patient-physician relationship.

Overview

With the flu season upon us once again, geriatric care professionals should pay special attention to the prevention and treatment of influenza in their older patients. Influenza is a lower respiratory tract viral infection of ciliated cells. The elderly are among the most vulnerable to influenza. Older individuals who suffer from chronic illnesses or who live in long-term care (LTC) facilities are at even greater risk for complications of influenza such as pneumonia. Roughly 90% of influenza and pneumonia victims are older than age 64, and the highest death rates from influenza and pneumonia among this age group are found in nursing homes. Influenza can increase risk for elderly patients to experience functional decline and can worsen pre-existing conditions and comorbidities.

Diagnosis

There are many signs that geriatricians can look for when diagnosing influenza in the elderly. Fever and cough are symptoms of influenza; however, the presence of sneezing is not an indicator that an older patient has contracted the virus. Virus cultures can help rule out influenza or help determine what virus type the patient is infected with. Selected laboratory rests for influenza A and B include viral cultures, immunofluorescence, DFA antibody staining, RT-PCR, serology, and enzyme immuno assay (EIA).

Prevention

Three main types of influenza prevention may be exercised: Primary, Secondary, and Tertiary.

Primary prevention encompasses compliance with vaccination programs. Vaccination is most effective against influenza and its complications in LTC environments. Both the elderly and those family or caregivers who have increased contact with the elderly should be vaccinated. Older patients should only be administered inactivated vaccines. The best time for vaccinations is October through mid-November, but patients should be vaccinated as needed throughout the influenza season, which includes most of the cold, or winter, months of the year.

Secondary prevention includes chemoprophylaxis, or the prevention of disease or infection with the use of drugs and/or food supplements. Chemoprophylaxis should not replace vaccination. It serves as further prevention when family, caregivers, or others in close contact with the elderly have been diagnosed with influenza. The medication should be taken daily for the duration of the influenza infection as soon as the virus has been diagnosed in someone at the institution or in close contact with the patient and should last for a minimum of two weeks.

Tertiary prevention is treatment of symptoms once they manifest themselves in the patient. This includes antipyretics, hydration, and proper nutrition. Available drugs for treatment are numerous and should be selected based on the individual patient’s comorbidities and cognitive status.