Advice From APHA Experts
Pandemic Flu and the Elderly: A Cause for Concern
In the event of a flu pandemic, health officials are predicting that older people will be among the hardest hit by the disease, both in terms of cases and deaths. But just how much at risk are the elderly?
Clues to the potential impact of avian influenza on the elderly can be drawn from historical accounts of previous influenza pandemics. During the 1918 flu pandemic, the majority of deaths occurred among people ages 30 to 50. The exact percentage of age-related mortality is not clear as a wide range of mortality was reported, from 20 million to 100 million deaths worldwide.
Data on the approximately 240 human flu cases caused by the H5N1 virus in recent years — leading to 140 human deaths — are mainly in young adults and older children. However, if the current H5N1 flu turns to become a pandemic, it is expected to affect all age groups.
If an H5N1 flu pandemic occurs in the near future, the expected mortality will be highest in immune-compromised individuals including the elderly, people with HIV/AIDS and people who are taking medications to suppress their immune system. Because of lower access to health care and crowded living conditions, the lowest socioeconomic segment of society will be the hardest hit during a pandemic.
Seniors living together at high risk
While the public health infrastructure has had many improvements since the 1918 pandemic, several risks for older adults still persist today. For the elderly, living in close proximity to one another in independent-living, assisted-living and nursing homes make the risk for rapid spread of a potentially lethal viral exposure particularly hazardous.
Health officials need to plan for rapid exposure in communal dwellings to prevent the potential impact of avian influenza on the elderly.
The common-sense practice of vaccinating the elderly to protect the elderly from the flu has been called into question. A study released in February 2005 reported there is no evidence flu vaccines help the elderly avoid death from the disease. This goes against the age-old practice of doctors advising people ages 65 and older to get flu shots. It has generally been assumed that the elderly are more likely to die if they get the flu.
Although flu deaths may be expected to drop as more elderly become vaccinated annually, researchers actually found the influenza death rate to be constant between 1968 and 2001 even though the percentage of seniors receiving shots increased from 15 percent in the 1970s to 65 percent in 2001. Should we still continue with the vaccines if they aren’t making a dent in mortality? According to the 2005 study, the answer is a definite "yes," with researchers calling for more effective vaccines. Physicians have well been aware that effectiveness of flu vaccines diminishes as people get older, as their immune systems don’t work as well.
As the seasonal flu season has become longer over the years, providing more time for the elderly to pick up the disease, vaccinations are more important than ever. While there is currently not a vaccine that will protect people from a flu pandemic, there may be one in the future. If so, such vaccines will be essential for the elderly.
People who are 65 and older are still considered the highest risk group in terms of influenza deaths and should exercise care in taking all necessary precautions, whether it is during the regular flu season or during a full-blown flu pandemic.
By Pierrette J. Cazeau, MBA/HSA, CCJ, CNPR, PhD; Capella University School of Human Services, West Palm Beach, Fla.; and Charles P. Mouton, MD, MS, FAAFP, AGSF, CMD, professor and chair of the Department of Community and Family Medicine, Howard University College of Medicine. Cazeau and Mouton are members of APHA's Gerontological Health Section.
References
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