For Older Adults, Preventing Flu is Key to Lessening Disability Risks

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Journal of the American Geriatrics Society Research Summary

We tend to think of the flu as an illness that people recover from within a relatively short time. Unfortunately, that’s not always the case for older adults, who are more likely to experience difficulties getting around and living independently following a serious illness. Adding to the problem is the potential for additional health problems that can occur during a stay in the hospital. Hospitalized older adults potentially face delirium, an abrupt change in mental function which causes sudden confusion. They are also susceptible to hospital-acquired infections and can weaken if they lose their physical conditioning.

In fact, studies show that one-third of older adults will be discharged from the hospital with a new disability — and only 30 percent of them will regain their pre-admission ability levels for bathing, dressing, feeding themselves, and managing other activities of daily living, even one year after their discharge.

A decline in your ability to take care of yourself can mean a greater need for in-home support, admission to a long-term care facility, and even an increased risk of death.

That’s why a team of researchers designed a study to learn more about functional decline (the ability to take care of yourself) and serious disability in adults, aged 65 years and older, who are admitted to hospital for influenza and other acute respiratory illnesses. Their study was published in the Journal of the American Geriatrics Society.

The Relationship Between Flu & Functional Decline

 The research team wanted to learn more about how common such declines are, and to see if they differed depending on whether people were hospitalized with influenza or with other types of respiratory illnesses. They also wanted to examine whether a person’s level of frailty at the start of their hospitalization affected functional decline and serious disability. Finally, they hoped to learn whether the relationship between frailty and serious disability was linked to a patient’s influenza status.

Participants in the study were hospital patients aged 65 or older who were enrolled in the Canadian Immunization Research Network’s (CIRN) Serious Outcomes Surveillance (SOS) Network during the 2011-2012 influenza season. In this season, the SOS Network included 40 hospitals across seven Canadian provinces.

The researchers studied information from participants who had tested positive for influenza or had acute respiratory illnesses such as asthma, COPD, lung embolisms and other infectious illnesses, including respiratory viruses, pneumonia, and sepsis.

The participants were screened for the following basic functional abilities: feeding, toilet use, bowel and bladder control, grooming, dressing, bathing, mobility, stair climbing, and the ability to get in and out of a bed and chair. For each item on the index researchers used to measure these abilities, a score of 10 means independence, 5 means need for assistance, and 0 means complete dependence.

A total score of 100 indicates complete independence, with decreasing scores indicating increases in disability. A loss of 10 to 20 points was considered to represent a meaningful moderate functional decline, whereas a loss of 20 or more points was considered catastrophic.

A total of 925 patients were enrolled during the 2011-2012 influenza season. On average, the participants were around 80 years of age, slightly more than half were women, and 37 percent had influenza.

Both groups had experienced a similar loss of ability from the time of their diagnosis to their admission to the hospital. Of the participants, 78 died, twice of whom had influenza compared to other respiratory illnesses. Those who died had lower functional scores at baseline (an average of 62), and those who survived had higher baseline functional scores (an average of 85).

Nearly 20 percent of surviving patients experienced lasting declines in their ability to function. Of them, eight percent experienced moderate functional decline and 10 percent experienced catastrophic functional declines. The frailer a patient was, the higher their chances were for experiencing serious functional decline.

A total of 170 patients experienced a catastrophic outcome, meaning they were either very seriously disabled or they died.

The researchers concluded that among older Canadians admitted to network hospitals during the 2011-2012 influenza season, people in both the influenza and other acute respiratory infection groups experienced a loss of their ability to function. Although many of them returned to their original level of function, nearly 20 percent experienced a meaningful loss of function within 30 days after their hospital discharge — of whom half experienced a catastrophic disability.

Prevention is Key

According to the researchers, this is the first study to specifically report on functional declines following hospitalization for influenza.

The researchers noted that their study highlights the importance of disease prevention and management in order to avoid hospitalization from any cause. Preventing hospitalization, including by having influenza and pneumococcal (pneumonia) vaccination, is key to preventing functional decline and catastrophic disability in older adults..

This summary is from “Persistent functional decline following hospitalization with influenza or acute respiratory illness.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Melissa K. Andrew, MD, PhD; Sarah MacDonald, MD; Judith Godin, PhD; Janet E. McElhaney, MD; Jason LeBlanc, PhD; Todd F. Hatchette, MD; William Bowie, MD; Kevin Katz, MD; Allison McGeer, MD; Makeda Semret, MD; and Shelly A. McNeil, MD.

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