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Respiratory Infections in the Elderly: Common Cold and Influenza

This module provides an overview of respiratory infections such as the common cold and influenza in the elderly, with a focus on their symptoms, prevention, diagnosis, and treatment. It also covers the importance of vaccination and the use of antiviral medications.

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Respiratory Infections in the Elderly: Common Cold and Influenza

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  1. Infectious Disease in the Elderly in Community and Long Term Care Facilitiesmodule 1Respiratory diseases:Common cold and InfluenzaUnit two UNMC Section of Infectious Diseases Brandi L. Lesiak, PA-C, MPAS Kim Meyer, PA-C, MPAS Claudia Chaperon APRN, Phd Ed Vandenberg MD CMD Updated 11-23-06

  2. PROCESS A series of modules and questions Step #1: Power-point module with voice overlay Step #2: Case-based question and answer Step # 3: Proceed to additional modules or take a break

  3. Overview of Goals • To review the major points of Unit one -GI infections: gastroenteritis/colitis, hepatitis -GU infections: UTIs Unit two -Respiratory: URIs, influenza, pneumonia, & sinusitis • To emphasize the role these infections play in the elderly/nursing home patients

  4. objectives Upon completion, the learner will be able to: • List the common symptoms and pathogens for URIs • Describe the presentation of influenza • List the prevention, diagnosis, prophylaxis and treatment of Influenza in the elderly.

  5. Respiratory Infections

  6. Respiratory Infections • Upper Respiratory Tract Infections • Influenza • Bacterial pneumonia • Sinusitis

  7. Upper Respiratory Tract Infection • Multitude of symptoms: • Nasal congestion • Rhinorrhea • Sore throat • Headache • Cough • Low grade fever • Typically lasts 7-10 days • Viral • May progress to sinusitis, bronchitis, pneumonia

  8. Upper Respiratory Viral Pathogens Treatment . . . .???

  9. Safest Symptomatic treatment

  10. Influenza

  11. Symptoms of Influenza vs Common coldKingston AFP 1/1/02

  12. CONTROL OF INFLUENZA • IMPORTANT MEASURES • 1) VACCINATE-employees, nursing staff, and LTCF patients • 2) AVOID VISITS FROM YOUNG CHILDREN AND THOSE WHO ARE ILL • 3) POST A SIGN ASKING PEOPLE TO AVOID LTCF IF CURRENTLY SYMPTOMATIC • 4) CONTACT AND DROPLET PROTECTION • 5) TREATMENT & CHEMOPROPHYLAXIS • TREATMENT-supportive in patients that have had symptoms of more than 72 hours

  13. PreventionImmunization: Influenza Vaccine • > 65 y ….all patients • < 65 if Chronic health conditions • Herd immunity reached with vaccination rates > 80% staff and residents • More effective to immunize staff than residents !!! How well are we doing? (1) • 2003: > 65 yo: influenza 68% US (of all elderly) influenza 74% NE (of all elderly)

  14. The End of Module One on Respiratory infectious diseases in the Elderly

  15. Post-test Which of the following is the most effective and least costly strategy to prevent exacerbation of chronic illness, hospitalization, and death due to influenza in elderly patients? A. Outbreak prophylaxis with oseltamivir or zanamivir for all residents and staff B. Outbreak prophylaxis with amantadine or rimantadine for all residents and staff C. Treatment with oseltamivir or zanamivir for all residents and staff D. Annual vaccination for all residents E. Annual vaccination for all residents and staff Used with permission from: Murphy JB, et. al. Case Based Geriatrics Review: 500 Questions and Critiques from the Geriatric Review Syllabus. AGS 2002 New York, NY.

  16. Answer: E. Annual vaccination for all residents and staff In frail older adults, influenza vaccine attenuates or prevents illness due to influenza A and B by 30% to 40%. More importantly, hospitalization for confirmed influenza, influenza-like illnesses, and cardiopulmonary complications are reduced by 60% during influenza season; mortality is reduced by 80% in older patients. Overall, vaccination is highly cost-effective. The efficacy is further enhanced if both patients and staff are vaccinated.

  17. The neuraminidase inhibitors oseltamivir and zanamivir are active against both influenza A and B. Expectant treatment with these agents has not been assessed in frail older adults in the community or nursing home. In healthy young and older adults, treatment has reduced febrile illness, the duration of symptoms by several days, and the number of antibiotic prescriptions written. Amantadine and rimantadine are approved for prophylactic use in the United States. They are active only against influenza A, and resistance emerges in 30% of patients. These agents are considerably less expensive than the neuraminidase inhibitors. Amantadine requires careful dosing and monitoring of renal function. end

  18. Resources (1) www.cdc.gov/flu accessed 7-17-06

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