For most, the flu is a mild yet unpleasant illness. Fever, chills, congestion, sore throat, muscle aches and fatigue generally leave people feeling lousy for a few days. Those who catch the flu often do not need medical care and fully recover in less than two weeks. However, seniors and individuals with compromised immune systems face very different risks.

The flu can cause serious complications like pneumonia and bronchitis that may necessitate hospitalization. In some cases, these complications can even be fatal. According to the Centers for Disease Control and Prevention (CDC), adults 65 and older accounted for between 70 and 85 percent of flu-related deaths and between 50 and 70 percent of flu-related hospitalizations in recent years.

“Elderly people who have chronic health conditions are particularly at risk for several reasons,” explains Tom Skinner, senior public affairs officer for the CDC. “First, the immune system weakens with age, leaving older adults more vulnerable to disease. Secondly, chronic health conditions can exacerbate the flu, making it worse, which leads to serious complications.” Likewise, the flu can make chronic health problems worse.

Medical Conditions That Increase the Risk of Flu-Related Complications

The CDC specifies the following chronic conditions as factors that heighten a senior’s risk of developing flu-related complications, such as pneumonia, sinus infections and ear infections.

  • Diabetes: People with diabetes (type 1 or type 2) are at high risk of developing complications of influenza. Contracting an illness like the flu can affect blood glucose levels and cause dangerous spikes and/or drops in blood sugar. Diabetics typically have weaker immune systems, which means that even minor infections can become life-threatening very quickly.
  • Chronic Respiratory Conditions: People with asthma, lung disease and chronic obstructive pulmonary disease (COPD) are more susceptible to flu complications due to their already compromised lung function. Any respiratory infection, including the flu, can cause inflammation and constricted airways, making it difficult to breathe and get adequate oxygen. This inflammation can lead to an increase in asthma attacks and COPD exacerbations. In fact, the CDC states that adults with asthma are more likely to develop pneumonia after contracting the flu virus than those without.
  • Heart Disease: While heart conditions don’t necessarily increase a senior’s risk of contracting the flu, they certainly increase the risk of dangerous complications. Individuals with heart disease, congenital heart defects, congestive heart failure (CHF), coronary artery disease or a history of stroke who contract the flu have an elevated risk of heart attack and stroke, which can be deadly. Research has shown that the risk of heart attack is six times higher during the seven days after a confirmed diagnosis of the flu.
  • Kidney Disorders: Chronic kidney disease can weaken the body’s ability to fight off infections like the flu. Consequently, the flu can exacerbate symptoms of kidney disease and damage these vital organs. Individuals who have received a kidney transplant and contract the flu could even end up rejecting the new kidney.
  • Liver Disorders: Just like in individuals with limited renal function, the flu can exacerbate liver disease. Flu can also cause the body to reject a transplanted liver. Unfortunately, the medications that individuals with liver and kidney disease can take to help treat the influenza virus and manage flu symptoms are limited because many of them are metabolized by these organs. If the kidneys and liver are already compromised, then taking certain medications can cause additional harm.
  • Neurological Conditions: Health problems like epilepsy, Parkinson’s disease, history of stroke and Huntington’s disease can weaken the body’s ability to fight off the flu.
  • Cancer and HIV: Any disease or treatment plan that causes a weakened immune system, such as HIV or chemotherapy for cancer treatment, can increase a person’s likelihood of contracting the flu and developing related complications.

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How to Prevent the Flu and Flu-Related Complications

To reduce the risk of a senior contracting the flu and developing serious complications, the National Council on Aging (NCOA) recommends that elders and their family members receive annual flu vaccinations. “Prevention is critically important,” urges Richard Birkel, PhD, former senior vice president of NCOA. The flu vaccine is updated each year based on data from a worldwide virus tracking system that helps public health officials predict which virus strains will circulate during the upcoming season.

People age 65 and over have three vaccine options: the traditional flu shot, the higher dose flu shot and the adjuvanted flu shot. (Seniors should not receive a nasal spray vaccine.) The higher dose shot is designed specifically to address the age-related decline of the immune system by prompting the body to produce more antibodies against the flu virus than would be produced by the traditional shot. Similarly, the adjuvanted flu shot contains an additive that generates a stronger immune response to vaccination than the traditional shot.

It’s best to receive a seasonal flu vaccine each year by the end of October before flu season spikes. However, the CDC encourages the public, especially those who are at high risk for complications, to get vaccinated through November, December and even January. Depending on the length and severity of the year’s flu season, vaccination efforts may continue into spring.

Because pneumonia is a common complication of the influenza virus, pneumococcal vaccines are also recommended for all adults over age 64. In addition to pneumonia, pneumococcal disease can cause dangerous infections of the bloodstream (bacteremia) and the linings of the brain and spinal cord (meningitis). Both influenza and pneumococcal vaccines are covered by Medicare Part B with no copay as long as the administering health care provider accepts assignment.

Treating the Flu

Older adults and those who are at higher risk of developing influenza-related complications should contact their primary care doctor as soon as they begin experiencing flu symptoms. A physician will be able to recommend appropriate over-the-counter medications to help manage symptoms and determine if the patient would benefit from a prescription antiviral drug, such as oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) or baloxavir marboxil (Xofluza). These drugs can help shorten the infection slightly, which can reduce the risk of additional health setbacks. Swift action is important when it comes to treating the flu because antiviral drugs are best started within 48 hours of exposure to the virus or the onset of symptoms.

Signs of Serious Flu Complications

Seek emergency medical care right away if you notice any of the following symptoms in an elder who you know or suspect has flu:

  • Difficulty breathing
  • Chest pain
  • Purple or blue discoloration of the lips
  • Vomiting and inability to keep liquids down
  • Signs of dehydration, such as feeling dizzy when standing and inability to urinate
  • Seizures (uncontrolled convulsions)
  • Confusion
  • Changes in responsiveness
  • Severe weakness
  • Worsening of preexisting chronic medical conditions

Sources: People 65 Years and Older & Influenza (https://www.cdc.gov/flu/highrisk/65over.htm); Flu and People with Diabetes (https://www.cdc.gov/flu/highrisk/diabetes.htm); Flu and People with Asthma (https://www.cdc.gov/flu/highrisk/asthma.htm); Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection (https://www.nejm.org/doi/full/10.1056/NEJMoa1702090?query=featured_home); You, Kidney Disease and the Flu (https://www.health.ny.gov/publications/2447.pdf); You, Liver Disease and the Flu (https://www.health.ny.gov/publications/2448.pdf); Pneumococcal Vaccination (https://www.cdc.gov/vaccines/vpd/pneumo/index.html); Flu shots (https://www.medicare.gov/coverage/flu-shots); Pneumococcal shots (https://www.medicare.gov/coverage/pneumococcal-shots); What You Should Know About Flu Antiviral Drugs (https://www.cdc.gov/flu/treatment/whatyoushould.htm)