Swine Flu and the Elderly

Last Editorial Review: 10/21/2009

Experts share insights on ways seniors can protect themselves against swine flu.

By Wendy C. Fries
WebMD Feature

Reviewed by Louise Chang, MD

Pandemic. If the word has you a little nervous, you're not alone. Though a pandemic simply refers to an epidemic that's widespread, when applied to terms like novel influenza A (H1N1), H1N1 flu, or swine flu, it can sound confusing and a little scary.

Some perspective can help. Certainly the spread of H1N1 swine flu is serious. Yet so is seasonal flu, which hospitalizes more than 200,000 people a year in the U.S. Both types of flu have similar symptoms, including fatigue, chills, headache, body aches, stuffy nose, sore throat, cough, and fever. And if you get sick, the only way to tell which flu you have is to be tested by your doctor.

So what is it about swine flu that has people so nervous? Should seniors in particular be worried? To learn more, WebMD went to medical experts and got their answers to these and other questions about the H1N1 virus.

Why is swine flu a particular worry?

Swine flu is a novel form of the influenza virus, combining swine, human, and avian virus strains. Because it is new, people in general don't appear to have antibodies against it as they might against seasonal flu. That means potentially more people could get sick with this flu.

Are seniors particularly susceptible to swine flu?

H1N1 swine flu doesn't seem to be a big problem for seniors unless that person has a chronic underlying condition, says Thomas Yoshikawa, MD, professor of medicine at the David Geffen School of Medicine at UCLA and editor-in-chief of the Journal of the American Geriatrics Society.

Most H1N1 cases are occurring in younger people. "It appears that older persons, who have been exposed multiple times in their life time with various flu outbreaks, may have residual immunity of which some of it is against this H1N1 flu strain," Yoshikawa tells WebMD.

However, underlying health problems like heart and lung diseases or a compromised immune system "confers an increased risk of influenza, whether it's swine flu or another type of flu," says Sean X. Leng, MD, PhD, a geriatrician conducting research on influenza immunization in older adults and assistant professor of medicine at Johns Hopkins University School of Medicine.

Though healthy seniors haven't been particularly targeted by H1N1 swine flu, seasonal influenza remains a deadly risk for many, with roughly 36,000 people in the U.S. dying from flu-related causes every year. A yearly flu vaccination remains an important way to stay flu-free.

Should seniors get a swine flu vaccine if it becomes available?

"Absolutely yes," says Yoshikawa.

Leng agrees. "When the vaccine is available I would recommend my patients get it."

Yet while many experts expect a swine flu vaccine by fall, there won't initially be enough vaccine for everyone. That's why some officials are recommending that when the H1N1 flu vaccine is available, it should first be administered to pregnant women, health care workers, people taking care of infants less than 6 months old, children and young adults between 6 months to 24 years old, and those between 25 and 64 with underlying health problems.

Even when there is enough H1N1 vaccine to go around, it's important to remember that this vaccine won't protect against seasonal flu, too. You'll need to get a seasonal flu vaccination as well.

What steps can seniors take to protect themselves against swine flu?

The most common ways of getting the flu are being exposed to people with the flu who are sneezing, coughing -- even breathing -- nearby, or by touching objects that were previously handled by a person with flu.

"I'm telling my patients that if someone in the immediate family or close contact has any flu-like symptoms ... they need to stay away from those people; those people also need to isolate themselves and seek care," says Leng. Once you have symptoms of the flu, you should contact your doctor, says Leng.

"Whenever possible, seniors should avoid anyone who might appear to have flu symptoms," advises Yoshikawa. "Washing your hands with disposable paper towels rather than shared cloth towels minimizes spread of the flu onto your hands and face."

Carrying alcohol-based hand gels and cleaning your hands whenever you go to public places may also help remove or kill the flu virus, Yoshikawa tells WebMD.

What type of treatment should a senior with swine flu follow? Can they take antivirals?

"If a senior comes down with symptoms compatible with a flu, they should see their doctor right away," Yoshikawa says. "Taking antivirals early in the course of the flu (preferably before all symptoms start but by 48 hours into the course of the infection) can reduce the severity of the disease." Antivirals can also help prevent flu and its complications.

The antivirals recommended as effective against H1N1 flu are oseltamivir (Tamiflu) and zanamivir (Relenza).

What precautions should caregivers of the elderly or those in retirement homes take to protect themselves from swine flu?

There are always universal precautions to help prevent the flu, says Leng. If you're seeing patients, make sure you wash your hands, and if you're caring for someone with flu symptoms, "you really need to wear a mask," Leng tells WebMD.

Additionally, in a retirement community setting, "if someone gets flu-like symptoms, I would suggest they stay in their own apartment, and if diagnosed they really need to be isolated." Yet sometimes a senior may not realize they have flu-like symptoms. In that case the caretaker may want to take the extra step and get that person to seek care if they have symptoms, suggests Leng.

And as a caregiver you need to protect your patients by staying home if you become ill and avoiding especially those at high risk for complications from influenza.


A Cold or The Flu? How to Tell the Difference See Slideshow

If I follow the standard flu precautions will they help me avoid swine flu?

Yes they should, say the experts. The CDC recommends:

  • Covering your nose and mouth with a tissue when you cough or sneeze. Then throw the tissue away.
  • Wash your hands often with soap and water, especially after coughing or sneezing.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home if you get sick and limit your contact with others.

The CDC also advises avoiding crowds and heeding school advice about school closures. "These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections," says the CDC in a Q&A on the pending H1N1 vaccine.

What are the warning signs that I may need emergency medical care for swine flu?

If you do get the H1N1 virus, you may be sick for a week or longer, reports the CDC. They suggest staying home from work for at least seven days after symptoms begin, or until you've been symptom-free for 24 hours. If you experience any of these signs while having the flu, the CDC suggests seeking urgent medical care:

Health Solutions From Our Sponsors


Joseph W. Stubbs, MD, FACP, president, American College of Physicians.

Aaron E. Glatt, MD, FACP, FIDSA, FSHEA, president and CEO, New Island Hospital; professor of clinical medicine, Bethpage, N.Y.

Sean X. Leng, MD, PhD, assistant professor of medicine, Johns Hopkins University School of Medicine.

Thomas Yoshikawa, MD, professor of medicine, David Geffen School of Medicine, UCLA; editor-in-chief, Journal of the American Geriatrics Society.

CDC: "A Pandemic Is Declared," "Q&A: Novel H1N1 Influenza Vaccine," "What to Do If You Get Flu-Like Symptoms," "What Pregnant Women Should Know About H1N1 (Formerly Called Swine Flu) Virus." "Novel H1N1 Flu (Swine Flu) and You," "Influenza: The Disease," "What is Influenza (Also Called Flu)?"

World Health Organization: "What Is the New Influenza A(H1N1)?" "What Can I Do?" "Pandemic (H1N1) 2009 Briefing Note 4," "Pandemic (H1N1) 2009 Briefing Note 2."

PandemicFlu.gov: "H1N1 (Swine Flu) Immunization Campaign."

WebMD Medical Reference: "Flu Complications."

Reviewed on August 12, 2009

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