Alzheimer's, Dementia & Mental Health
Senior Citizens with Dementia at Much Higher Risk of
Dying with Flu, Not So Likely to Get It
Limited access to health care, inadequate testing
may contribute to higher rates of mortality and lower rates of
diagnosis of flu in elderly with dementia
Oct. 27, 2009 – Senior citizens (age 65 and over)
with dementia are diagnosed with flu less frequently, have shorter
hospital stays, but have a fifty percent higher rate of death than those
without dementia, according to an epidemiological study on pneumonia and
influenza (P&I).
“The increased mortality of older patients with
dementia hospitalized for flu may be indicative of inadequacies in
health care quality and accessibility,” says senior author Elena Naumova,
PhD, professor of public health and community medicine at Tufts
University School of Medicine.
“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.”
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
Journal of the American Geriatrics Society.
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.
About Source
Naumova EN, Parisi
SM, Castronovo D, Pandita M, Wenger J, and Minihan P. Journal of the
American Geriatrics Society. “Pneumonia and influenza hospitalizations
in elderly people with dementia.” Published online in advance of print,
October 26, 2009, doi: 10.1111/j.1532-5415.2009.02565.x.
