Flu Mortality Risk Increases for Older Patients with Dementia

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 50 percent higher rate of death than those without dementia.

The three-pronged study, which analyzed geographic and demographic patterns of pneumonia and influenza and the relationship between pneumonia and influenza and healthcare accessibility, was published online in advance of print in Journal of the American Geriatrics Society.

“The increased mortality of older patients with dementia hospitalized for flu may be indicative of inadequacies in healthcare 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 healthcare 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 pneumonia and influenza rates were highest among older adults in poor and rural areas, where there is a lower concentration of healthcare facilities. 

“Limited access to specialized healthcare 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 pneumonia and influenza  diagnosis. Of these records showing a pneumonia and influenza diagnosis, over 800,000 (13 percent) also showed dementia. The demographic and geographic patterns of pneumonia and influenza 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.

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.

Reference: 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.

Source: Tufts University School of Medicine