Within the last month, the Centers for Disease Control (CDC), issued a report regarding last years flu season, indicating it was the deadliest since 1976 when the CDC began collecting such information. In all, over 80,000 Americans died in 2017-2018 from the flu and its complications.
Flu season runs roughly from October through May, and even in years where the influenza outbreak is considered mild, far too many Americans die. There are certain groups that are over-represented among those who experience complications -- young children, pregnant women, people with long-term and chronic illnesses and the most vulnerable, our older adults.
When it comes to the flu, there are still many people who do not understand just what this infection does. Many people we spoke with believe the flu is just diarrhea, vomiting and a fever. This is not the case. Flu is a viral respiratory disease, and it leads to high and persistent fever, headaches, coughs, muscle pains, and runny noses that make those who contract it miserable.
According to the CDC, there are four kinds of the flu virus – A, B, C and D. The seasonal flu is caused by virus types A and B. As these viruses evolve, different strains show up every year. During last year’s deadly flu outbreak, it was the H3N2 strain of influenza A that invaded America. This strain causes more health complications than the other types of flu virus and is much more difficult to prevent.
Those in the medical profession have known for years that adults, 65 and above, top the list as the most at risk to develop complications, mostly due to their immune system breaking down with age and pre-existing conditions.
The CDC estimates that between 70 and 85 percent of seasonal flu deaths occur in those over the age of 65. And of those hospitalized, one-half to three-quarters are seniors over the age of 65. So, when looking at the numbers, it becomes apparent just how serious the flu can be among our seniors.
Please watch this video regarding the CDC's concerns about the upcoming flu season and the seriousness of last years -- when deaths were the highest in over 40 years.
So, just what does the flu look like in older adults? Typically, an infected senior may present with the following symptoms:
Runny or stuffy nose
Body aches and chills
And in some people, they may indeed vomit or have diarrhea, but it is always accompanied by respiratory problems.
But here is the rub, not all seniors exhibit typical flu like symptoms. In fact, a recent
study with older adults diagnosed with the flu found that 26 percent of them did not exhibit the typical flu like symptoms of a fever, sore throat and cough. The question is then why?
Well, it appears this is due to two common issues of aging – a weakened immune system and a decrease in the “physiologic reserve”.
The immune system in young, healthy people with the flu will exhibit the typical symptoms usually associated with the infection. But in a weakened immune system, the symptoms tend to be less prominent as the senior’s body just cannot generate the vigorous fight against invading diseases. This lack of immune system activity tends to manifest in the absence of a fever – the usual sign of a healthy body’s fight against a virus.
And just what is physiologic reserve? It’s the body’s ability to carry out key functions even when a disease is present. As an example, when a young person has the flu, he or she can still walk, stand, think rationally as the body keeps all major organs functioning appropriately. For instance, when standing up quickly, the body is able to adjust the blood pressure to maintain stability even while the immune system is working in over-drive to fight the virus.
The body is at its peak resilience in the mid-twenties and has an extreme amount of capacity to fight multiple physical stressors. When a young person does suffer the inability to stand or function, this is a sign that the illness is quite severe. But as we age, it doesn’t take a severe illness to affect the basic functions of the body.
And like many other things, not every human body is built the same or reacts the same. Seniors of the same age can have differing levels of physiological reserve depending on their health and overall fitness. But there is one truth, as we age, our bodies and minds become less resilient and therefore it takes less stress to cause the body’s systems to malfunction.
In older adults who are sick, some of the non-specific signs such as weakness and delirium become the first signals that something is wrong. For those with heart or breathing problems, a sudden worsening of these conditions may occur, reflecting the body’s inability to handle additional stress on the system. In other words, the body is malfunctioning because it cannot keep up with the invading virus.
Someone with heart disease or chronic obstructive pulmonary disease (COPD) already has added stress on the body. Add to this a viral infection like the flu and the body cannot handle the overload and starts to break down. The first parts to go are the weakest links -- those already damaged or experiencing problems.
So instead of the typical fever, sore throat or cough, older adults may experience the following non-specific signs as a result of the flu infection:
Loss of appetite
Confusion and poor levels of cognitive functioning (not associated with diagnosed Alzheimer’s or dementia)
Lack of energy or motivation
Or a worsening of pre-existing conditions:
COPD suddenly becomes worse, shortness of breath is more pronounced and there is increased production of mucous
Heart failure dramatically worsens including breathing problems and increased swelling of the legs
Symptoms of asthma increase.
Given what medical professionals know about the problems associated with the flu, getting the seasonal flu vaccine is the best protection against influenza and its complications. Ideally, this should be done annually and by the end of October however as long as the viruses are circulating, it is never too late to be vaccinated.
Let’s take a look at the types of flu shots available for seniors.
First of all, seniors should never use the nasal vaccine as research has shown it to be less effective than the shot -- that's in all age groups. There are two vaccines, however, that are specifically designed for those over 65. These are the High Dose Flu Vaccine and the Adjuvanted Flu vaccine.
High Dose Flu Vaccine
This vaccine contains 4 times the amount of antigen as a regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production). Clinical trial results show that seniors over 65 had 24% fewer influenza infections as compared to those who received the standard dose flu vaccine.
Adjuvanted Flu Vaccine
This vaccine is made with an additive that creates a stronger immune response to vaccination. In a Canadian study of people aged 65 years and older conducted during the 2011-12 season, the Fluad vaccine was 63% more effective than regular-dose unadjuvanted flu shots.
The high dose and adjuvanted flu vaccines may result in more of the mild side effects that can occur with the normal dose vaccines. These side effects can include pain, redness or swelling at the injection site, headache, muscle ache and malaise.
Besides the flu vaccine, it is also important that seniors receive pneumococcal vaccines. These vaccines protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
Other preventive actions include covering coughs, washing hands often, and avoiding people who are sick.
If you think you have been exposed to the flu and begin to feel sick or exhibit flu symptoms, contact your health provider immediately. There are anti-viral drugs, if used within 48 hours of the onset of symptoms, that can treat the illness and help prevent serious complications. The CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk for serious flu complications, such as people 65 years and older.
The anti-viral drugs being used to treat the flu include:
Oseltamivir (available as a generic version or under the trade name Tamiflu),
Zanamivir (trade name Relenza)
Peramivir (trade name Rapivab)
A new anti-viral flu drug, called Xofluza, was approved for use this fall by the Food and Drug Administration.
In an interview with CBS News, Dr. Robert Glatter, an emergency physician at Lenox Hill
Hospital in New York City spoke about this new anti-viral medication, “Xofluza is unique in that it acts to inhibit replication of the flu virus at a step much earlier than the current medications available, such as oseltamivir or zanamivir, which only block release of virus that has already been produced from a host cell.”
Because of the way Xofluza works, it appears to be able to "reduce and shorten the duration of bothersome symptoms, such as fever and muscle aches," he said. "In theory, it might also reduce the chance of developing downstream complications such as pneumonia."
Xofluza is also "simpler to take -- just one tablet, compared with other options, one of which requires twice daily dosing for 5 days," Glatter said. The most common side effects noted in patients taking Xofluza were diarrhea and bronchitis.
Among some local medical providers we spoke with, they are still evaluating the drug for use in their practice. Those things under review include efficacy, other drug interactions and cost to the patient, however they expect to make a rapid decision given that we are at the beginning of the flu season.
Even with the best of care, people will become ill. Should that occur, monitoring the progression of the illness is imperative in order to prevent more serious complications. If a loved one over the age of 65 experiences any of the following symptoms:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Severe or persistent vomiting
Flu-like symptoms that improve but then return with fever and worse cough
Seek emergency care immediately. These symptoms could indicate the onset of complications -- especially among those with pre-existing illnesses -- and always err on the side of caution and contact a medical professional or go to the emergency room.
Unfortunately, not all deaths from the flu are preventable, even with the flu vaccine and taking the necessary precautions, but we can do better. With the help of informed and proactive families, medical professionals and everyone who works with seniors, we can help more older adults get the care they need and reduce the serious complications and deaths from the flu.
Below we have two documents from the Centers for Disease Control (CDC). Please click on them, download and print.
This document discusses the need for the flu vaccine.
This document discusses treating the flu in seniors.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.