Dr Janet McElhaney, Professor of Medicine and the Alan M. McGavin Chair in Geriatrics Research, Department of Medicine, University of British Columbia, Vancouver, Canada, says the link between chronic long-term illnesses and influenza has received insufficient attention.
Speaking at the Geneva Health Forum, Dr McElhaney noted that older people with certain non-communicable diseases (NCDs) are at higher risk of contracting influenza and are more likely to suffer severe illness following infection.
“This is not necessarily about people dying from NCDs [non-communicable diseases] but suffering from loss of independence in their daily lives; something which threatens to overwhelm health and social systems,” she told a satellite meeting on the prevention and management of NCDs such as diabetes, heart disease, respiratory disease and cancers.
With Europe’s population living longer than ever before, the importance of preserving independence in older age groups is climbing up the health policy agenda.
“Elderly people with chronic conditions have higher attack rates and are more likely to suffer from serious flu-related complications,” she said.
The elderly are at an increased risk of hospitalisation and this has long been associated with a decline in independence, their ability to function daily without assistance. Around one third of people aged 65 and older leave after hospitalisation less able to manage daily tasks than before they were admitted to hospital.
Dr McElhaney says being hospitalised with a flu infection can mark the beginning of a period of irreparable decline. Her aim is to keep older people out of hospital for as long as possible, in an effort to preserve their independence.
To achieve this, Dr McElhaney – an academic researcher and practising geriatrician – recommends vaccination of older people against influenza. She said the priority for geriatricians should be to “add life to years” by concentrating on promoting quality of life for older people.
“Influenza significantly contributes to the disability suffered by people with non-communicable diseases. However the risk of hospitalisation and frailty can be reduced by immunisation,” she said.
While policymakers have focused on the need to reduce the risk of developing chronic illnesses by promoting healthy behaviour, insufficient attention has been given to preventable acute illnesses, such as influenza, which can have long-term effects on older people.
Dr Bram Palache of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) task force on Influenza Vaccine Supply (IVS), and a member of the EVM influenza working group, said the link between influenza and non-communicable diseases has been underappreciated.
“We can see that preventing these flu-related hospitalisations can help people to stay healthy and independent for longer. I’ve long been convinced that flu immunisation is a no-brainer. But now, having seen Dr McElhaney’s presentation, I think it is appalling that we do not have a date in our agenda to remind us to get immunised every year,” he said.
Transcript of interview with Dr Janet McElhaney
Vaccines Today: Are people with chronic illnesses at higher risk of influenza?
Dr Janet McElhaney: Absolutely. People with chronic conditions have higher attack rates and are more likely to suffer from serious flu-related complications.
VT: How can those at risk be targeted by immunisation programmes?
JM: People are more likely to get vaccinated because they identify with a certain age group than because they have a chronic illness. We need to define risk groups so that people understand that they are members of a group that is at increased risk of influenza.
VT: What are the benefits of vaccinating older people?
JM: Vaccination helps to control outbreaks and, for those who are infected but survive, the risk of severe illness is reduced. We want to minimise what we call ‘catastrophic disability’: this is the dramatic loss of independence that can follow flu infection.
VT: Why is reducing hospitalisation so important?
JM:In people aged 65 and older who have been admitted to hospital, one third will be more disabled when they are discharged. Half of those will never make a full recovery. Influenza is often not picked up when older people go to hospital emergency rooms with chest pains or breathing difficulties. That’s another reason why we have to prevent these flu-related admissions.
VT: Immunisation can reduce the risk of disability but can it reverse disability?
JM:For people who were quite well and had a low frailty score before being infected by the flu, the chances of recovery are greater than those who were frail before a flu infection.
VT: What is the economic argument for vaccinating older people?
JM:On a per person basis it’s cost-saving.