Tuesday, June 16, 2009

Elderly Faring Better Than Expected With New Flu

Any new disease is cause for concern, especially when it’s potentially fatal. But the AH1N1 swine flu has confounded expectations by proving unusually benign for the elderly.

Of 538 confirmed cases of AH1N1 in New York City, only six have occurred among people ages 65 and over. “Normally flu would go right through long-term care facilities,” said Dr. Stephen Morse, professor of clinical epidemiology at Columbia University. “In a normal year, the elderly would have a much greater risk.”

This is no normal year. Preliminary evidence suggests that many older people may have residual immunity to the new flu virus because they were exposed to similar H1N1 viruses that circulated decades ago, before 1957. If so, that’s great news for both the elderly and their caregivers.

Still, Mayor Michael Bloomberg has consistently emphasized that all of the city’s AH1N1 flu fatalities have involved “underlying conditions” that exacerbated each victim’s risk. The list of conditions is long enough to worry almost any elderly person and includes heart disease, lung disease, diabetes and a weakened immune system. Even obesity is now being discussed as a condition that can lead to complications for this flu.

“The whole purpose of such a list is to help people predict [who needs special treatment],” said Dr. Morse. “This list is so long, all it tells you is that if you have the flu and you’re in anything other than perfect health, you should watch carefully.”

Translation for caregivers: Though the elderly have largely been spared, keep an eye out for flu symptoms and act quickly if any emerge.

New York City’s Department of Health and Mental Hygiene has put together an extensive fact sheet on AH1N1 (PDF). Among other information, it lists guidelines for treating those at higher risk for complications, including anyone 65 or older.

In the case of “influenza-like illness (PDF)” (meaning a fever of at least 100.4 degrees Fahrenheit, accompanied by a cough or sore throat), call the doctor right away. Antiviral medicine can turn a potentially serious illness into a mild one — especially if you start treatment within the first 36 to 48 hours. The doctor can phone in a prescription for Tamiflu if the patient meets the criteria.

If flu-like illness is accompanied by severe symptoms — for example, difficulty breathing, chest pain or dizziness — forget about risk factors and head for the hospital. (Absent serious symptoms, don’t bother. Going to the hospital won’t bring better care. It will just burden already overwhelmed emergency rooms.)

But so far, fortunately, there has been little reason for caregivers to call either the doctor or the E.R.

That could change if the virus grows more virulent as it moves through the Southern hemisphere in the coming months, as many scientists fear. “We’re back to watching and waiting,” said Dr. Morse. But for now, breathe a sigh of relief. Things could be much worse.

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