November 18, 2009

Deadly Connections

Study finds that older patients with dementia are at increased risk of dying from the flu

Older 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, according to a new study by Tufts researchers.

The increased rate of death of older patients with dementia who had been hospitalized for flu may be indicative of inadequacies in health-care quality and accessibility for those patients, says Elena Naumova, a professor of public health and community medicine at the Tufts School of Medicine, who led the study.

Based on this research, Naumova suggests that guidelines for the immunization, testing and treatment of flu in older patients with dementia be refined when planning for the possibility of flu pandemics.

The researchers combed through some 36 million hospitalization records from the Centers for Medicaid and Medicare Services, covering 1998 to 2002. More than six million records documented a pneumonia and influenza diagnosis, and of these, some 800,000 also showed dementia.

Dementia causes obstacles to the early diagnosis and treatment of flu, according to the study, which was published online in late October in the Journal of the American Geriatrics Society. Patients may have difficulty communicating symptoms, for instance. Limited access to health-care services and inadequate testing practices also may contribute to the higher rates of mortality and lower rates of diagnosis of flu seen in these patients. A geographic analysis of the data showed that pneumonia and influenza rates were greatest among older adults in poor and rural areas, where there are fewer health-care facilities and providers.

“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,” says Naumova. “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.”

Co-authors include Sara M. Parisi, N07, MPH07; Julia Wenger, MPH09; Manisha Pandita, a former research assistant in the Department of Public Health and Community Medicine at Tufts; and Paula Minihan, assistant professor of public health and community medicine.

Article Tools

emailE-mail printPrint