Bob DeMarco Alzheimer's Reading Room

Wednesday, October 28, 2009

Pneumonia and Influenza (Flu) Hospitalizations in Elderly People with Dementia


Limited access to specialized health care services can delay diagnosis and treatment of the flu, causing it to progress to pneumonia, the fifth leading cause of death among the elderly...It could be beneficial to refine guidelines for the immunization, testing, and treatment of flu in older patients with dementia when planning for the possibility of a flu pandemic. -- Elena Naumova, PhD, professor of public health and community medicine at Tufts University School of Medicine
By Bob DeMarco

People suffering from Alzheimer's and dementia have difficulty communicating pain and illness.

In the case of my mother, who suffers from Alzheimer's disease, she never complains or says she is feeling ill. This forces me to very diligent in checking her each day.

Four times this year my mother had a bladder infection. I first noticed that she felt warm, that she seem to be perspiring, and her eyes looked glassy. When I see this I take her temperature.

My mother's normal temperature is around 97.6. I now know from experience that when her temperature rises into the 98.2-98.4 area she likely has a bladder infection. It took me five years to learn this. How many bladder infections did my mother have before I learned this?

When my mother has a bladder infection she never complains of pain.

My mother also has headaches every day. She never complains. This is another thing I have to check frequently. The most worrisome of these headaches occurs when they are located on the top of her head -- this can be a sign of stroke, or mini-stroke. I have to sweat this out all the time.

I check the strength in her hands and legs, check for any numbness, and check to see if she can follow my finger with her eyes.

I am not a doctor -- this is very stressful. I have to stay alert all the time -- every time. I can't take a day off. Next time it could be serious.

I have been grappling with the issue of the H1N1 virus flu shot. What to do? I wrote about my decision recently.
H1N1 Flu Shot, Alzheimer's and Dementia -- Our Decision on the Shot
Delay of the diagnosis and treatment of the flu in the elderly frequently leads to pneumonia. In the case of H1N1 the accompanying pneumonia is devastating and life threatening.

I am receiving quite a few emails asking me what to do about the H1N1 flu shot.

My decision is contained in the article I referenced above. However, please remember I am not a doctor.

This is our personal decision. I believe each family should examine the evidence, consult with their doctor, and make the decision that is best for their loved one.
Subscribe to The Alzheimer's Reading Room--via Email

Older Patients with Dementia at Inceased Risk for Flu Mortality

An epidemiological study on pneumonia and influenza in adults age 65 and over reports that patients with dementia are diagnosed with flu less frequently, have shorter hospital stays, and have a fifty percent higher rate of death than those without dementia. The three-pronged study, which analyzed geographic and demographic patterns of P&I and the relationship between P&I and health care accessibility, was published online in advance of print in.

"The increased mortality of older patients with dementia hospitalized for flu may be indicative of inadequacies in health care quality and accessibility. It could be beneficial to refine guidelines for the immunization, testing, and treatment of flu in older patients with dementia when planning for the possibility of a flu pandemic," said first and senior author Elena Naumova, PhD, professor of public health and community medicine at Tufts University School of Medicine.

Dementia, defined by the authors as cognitive impairment to the extent that normal activity is impaired, causes unique obstacles to the early diagnosis and treatment of flu. Patients may have difficulty communicating symptoms and medical complications due to poor oral hygiene or impaired swallowing. Additionally, the authors believe that limited access to health care services and inadequate testing practices may contribute to the higher rates of mortality and lower rates of diagnosis of flu seen in older patients with dementia. A geographic analysis of the data showed that P&I rates were highest among older adults in poor and rural areas, where there is a lower concentration of health care facilities.

"Limited access to specialized health care services can delay diagnosis and treatment of the flu, causing it to progress to pneumonia, the fifth leading cause of death among the elderly. This study has helped us identify this vulnerable population, and now further study is needed to confirm the findings and assess the testing and vaccination policies for older patients with dementia," said Naumova.

Study data were obtained from the Centers for Medicaid and Medicare Services (CMS), and covered a span of five years, from 1998 to 2002. Of the 36 million hospitalization records for adults aged 65 and older, more than six million records documented a P&I diagnosis. Of these records showing a P&I diagnosis, over 800,000 (13%) also showed dementia. The demographic and geographic patterns of P&I hospitalizations and their links with hospital accessibility were explored. Pneumonia and influenza admissions, length of stay in a hospital, and mortality rates among elderly with dementia were compared to national estimates.

Elena Naumova is the director of the Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases (Tufts InForMID), which works to improve biomedical research by developing computational tools in order to assist life science researchers, public health professionals, and policy makers. The center is focused on developing methodology for analysis of large databases to enhance disease surveillance, exposure assessment, and studies of aging.

Co-authors include Sara M. Parisi and Julia Wenger, now graduates of the Master of Public Health program at Tufts University School of Medicine; Denise Castronovo, MS, Mapping Sustainability, LLC; Manisha Pandita, former research assistant in the department of public health and community medicine at Tufts University School of Medicine; and Paula Minihan, PhD, assistant professor of public health and community medicine, Tufts University School of Medicine.

This study was funded by the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences, both part of the National Institutes of Health.

About Tufts University School of Medicine
Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. The Sackler School undertakes research that is consistently rated among the highest in the nation for its impact on the advancement of medical science.

Popular articles on the Alzheimer's Reading Room

The Alzheimer's Action Plan: The Experts' Guide to the Best Diagnosis and Treatment for Memory Problemsstyle

Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. The Alzheimer's Reading Room is the number one website on the Internet for news, advice, and insight into Alzheimer's disease. Bob has written more than 800 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.
Original content Bob DeMarco, Alzheimer's Reading Room