CME: A Strategy for Decreasing Influenza’s Impact

CME: A Strategy for Decreasing Influenza’s Impact

Research indicates that about 60% of influenza-related hospitalizations occur in adults aged 65 and older during most influenza seasons in the United States. Many of these patients are frail and at increased risk for functional decline. However, few studies have assessed the need for extended care admissions due to functional decline from influenza-associated hospitalizations among community-dwelling older adults. Additionally, whereas studies have shown that prompt treatment with influenza antiviral agents can reduce the duration of illness and prevent influenza-related complications, data are limited on the benefit of antiviral treatment in this patient population.   Examining the Issue For a study published in Clinical Infectious Diseases, Nancy M. Bennett, MD, MS, and colleagues analyzed predictors of extended care and the potential mitigating effect of antiviral treatment among community-dwelling patients aged 65 and older. Participants were hospitalized with laboratory-confirmed influenza during the 2010-2011, 2011-2012, and 2012-2013 influenza seasons. Extended care was defined as placement in a skilled nursing facility on hospital discharge. Treatment was categorized as early (4 days or less) or late (more than 4 days) in reference to the date of illness onset. “We also assessed a series of variables to determine which predicted loss of functional status and extended care placement,” says Dr. Bennett. The researchers found that among more than 6,500 participants, 18% were discharged from the hospital to extended care facilities. “These patients went from living independently to requiring significant care,” Dr. Bennett adds. A univariate analysis found the following to be predictors of discharge to extended care: Increasing age (10% among those aged 65 to 74, 16% for those aged 75 to 84, and 30%...
A Strategy for Decreasing Influenza’s Impact

A Strategy for Decreasing Influenza’s Impact

Research indicates that about 60% of influenza-related hospitalizations occur in adults aged 65 and older during most influenza seasons in the United States. Many of these patients are frail and at increased risk for functional decline. However, few studies have assessed the need for extended care admissions due to functional decline from influenza-associated hospitalizations among community-dwelling older adults. Additionally, whereas studies have shown that prompt treatment with influenza antiviral agents can reduce the duration of illness and prevent influenza-related complications, data are limited on the benefit of antiviral treatment in this patient population.   Examining the Issue For a study published in Clinical Infectious Diseases, Nancy M. Bennett, MD, MS, and colleagues analyzed predictors of extended care and the potential mitigating effect of antiviral treatment among community-dwelling patients aged 65 and older. Participants were hospitalized with laboratory-confirmed influenza during the 2010-2011, 2011-2012, and 2012-2013 influenza seasons. Extended care was defined as placement in a skilled nursing facility on hospital discharge. Treatment was categorized as early (4 days or less) or late (more than 4 days) in reference to the date of illness onset. “We also assessed a series of variables to determine which predicted loss of functional status and extended care placement,” says Dr. Bennett. The researchers found that among more than 6,500 participants, 18% were discharged from the hospital to extended care facilities. “These patients went from living independently to requiring significant care,” Dr. Bennett adds. A univariate analysis found the following to be predictors of discharge to extended care: Increasing age (10% among those aged 65 to 74, 16% for those aged 75 to 84, and 30%...

Highlights from the 2013 Adult Immunization Schedule

The Advisory committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has issued the 2013 adult immunization schedule, posted online this week in the Annals of Internal Medicine. Because current levels of vaccine uptake for adult vaccines are low, the recommendations stress the importance of providers routinely assessing patients’ vaccination histories and providing routinely recommended vaccines. A strong recommendation from physicians offering vaccination has been associated with increased uptake of vaccines. Physicians are also encouraged to implement reminder/recall systems and standing orders. View figure of the Recommended Adult Immunization Schedule, or click here to download. Changes in the 2013 vaccination schedule include the following: PCV13. Updates have been added for the first time on the use of 13-valen pneumococcal conjugate vaccine (PCV13) and the timing of administration of PCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults. PC13 is recommended for immunocompromised adults aged 19 and older. The schedule also clarifies which adults would need 1 or 2 doses of PPSV23 before age 65. Tdap. Recommendations have been expanded to include routine administration of Tdap vaccination to adults age 65 and older as well as pregnant women. Pregnant women should receive the Tdap vaccine during each pregnancy, ideally between 27 and 36 weeks’ gestation to increase the likelihood of optimal protection for the woman, the fetus during pregnancy, and the first few months of the infant’s life. Influenza. The guidelines continue to recommend influenza vaccination for patients 6 months and older. Mild allergy to eggs is no longer a contraindication for the influenza vaccination – but patients with this allergy should receive the...

Protecting Older, Vulnerable Patients From the Flu

People aged 65 and older account for more than 60% of the estimated 226,000 flu-related hospitalizations and 90% of the 3,000 to 49,000 flu-related deaths in the United States each year. This age group is at highest risk for contracting influenza and developing its potentially serious complications, including pneumonia, bronchitis, sinus and ear infections, and coronary problems. Flu symptoms can even exacerbate other comorbid conditions. This puts patients at greater risk for complications and reduces quality of life. Collectively, these health issues can result in hospitalization and even death in older patients. Be Vigilant of Those at Higher Risk for Flu As the 2012-2013 influenza season continues and we look ahead to the next, it’s important to improve community-wide vaccination rates so that we can protect public health, especially when treating adults aged 65 and up. Seniors are at higher risk for influenza because the immune system weakens with age. In turn, the body’s ability to produce a sufficient amount of protective antibodies is reduced. When considering influenza vaccine resources for the season, it’s important to offer a variety of vaccine options and newer delivery systems. Merle C. Turner, DO A few years ago, the healthcare world received good news when a higher dose of the influenza vaccine was approved by the FDA for older patients. Designed for those aged 65 and older, the vaccine generates a stronger immune response because it contains four times the amount of antigen as the standard dose. While the high-dose vaccine has shown a higher risk for side effects at the injection site, there is no greater risk of a systemic reaction than...

Leading the Fight Against Flu

In 2009, the H1N1 influenza virus significantly changed the way most healthcare workers in the United States think about the flu. Collectively, we learned once again that the influenza virus is an unpredictable and serious threat to our patients’ health and well-being. Every year, influenza sickens 5% to 20% of all Americans, sending about 200,000 people to the hospital. What’s worse is that thousands die from the flu each year. The best means to prevent influenza illness is vaccination. This flu season, the Department of Health and Human Services is recommending seasonal influenza vaccination for everyone 6 months of age and older. Moreover, the CDC and the Advisory Committee on Immunization Practices continue to recommend that immunization programs focus initially on providing protection for people at greater risk for influenza-related complications, including: Pregnant women. Children younger than 5, but especially children younger than 2. Adults aged 65 and older. People with chronic medical conditions (eg, asthma, diabetes, or heart disease) associated with greater risk for medical complications from influenza. People working in healthcare settings are also among those at high-risk of getting and spreading influenza. Lead By Example Healthcare workers can serve as role models for vaccination because they can provide vaccines and set an example by getting vaccinated themselves. Research continues to show that the flu can spread rapidly throughout healthcare settings if proper precautions aren’t taken. Vaccination of healthcare workers reduces influenza infection and absenteeism, prevents mortality in other patients, and results in financial savings to sponsoring health institutions. However, influenza vaccination coverage among healthcare workers in the U.S. remains low. Recent mid-season estimates suggest that approximately...
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