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How elders can prevent infectious diseases
By Paula Sucoin, M.D.
The
current generation of adults aged 65 years and older were children at a time
when deaths from infectious diseases were common in young children and adults.
Vaccination and antibiotic therapy were not available to this generation in
their youth. Paradoxically, these seniors now face an increased risk of serious
illness from infectious diseases. The development of drug treatment and
vaccines allow the elderly patient to better deal with these increased risks of
illness.
What types of infections are elders at risk for?
Infections in the elderly can be divided into those which occur because of the aging process and those which are complications of diseases which are more common as a person ages. Examples of the former would include pneumonia and urinary tract infections; diabetic foot ulcers or infections complicating cancer treatment are examples of the latter.
How can the risk of the respiratory infections associated with aging be reduced?
Viral and bacterial diseases which are spread from person to person can be particularly serious in the senior patient. Family members and care givers can spread viruses, particularly during the winter “cold and flu” season. These viral infections can lower the ability of the body to fight off common bacterial infections and cases of pneumonia can follow. The influenza virus and the bacteria Streptococcus pneumoniae are causes of upper and lower respiratory infections. Symptoms may include cough, fever, shortness of breath along with severe weakness and muscle pains. Early diagnosis and treatment with the right medications are important to a good outcome. Prevention of these conditions begins with good hygiene such as handwashing — particularly with alcohol-based hand gels, which dry quickly and are as effective as rubbing with soap and water.
Covering coughs and sneezes is an effective way to prevent the spread of viruses and bacteria. The risk of influenza can be decreased by use of yearly vaccination against the viruses which are identified as likely to cause the disease in a given year. This vaccine has to be given yearly, since the strains shift from year to year. The Centers for Disease Control recommends vaccination for those 50 and older, young children and pregnant woman as an effective way to decrease winter-time spread of the disease. Antiviral medications can be given to sick patients diagnosed with the disease and can be used to prevent disease during outbreaks. The pneumococcal vaccination is recommended for seniors 65 and over. This vaccine, effective against the Streptococcus pneumoniae bacteria, helps decrease the incidence and severity of this common cause of bacterial pneumonia. The “pneumonia vaccine” does not protect against all types of pneumonia, however, and people who have received this injection may still present with pneumonia.
Are there other infectious diseases which occur in the elderly?
Infectious diseases of the bowel and urinary tract are more common as we age. The stomach may have lower levels of digestive acids, due to the aging process or because of use of medications to treat acid reflux or ulcer disease. This lower acid level increases the susceptibility to bacterial and viral agents of “gastroenteritis” or bowel infections. Careful attention to good hand hygiene and principles of safe food preparation can decrease this risk. Weakness of the bladder or lower abdominal and pelvic muscles may increase the likelihood of urinary infections as we age. Exercises, biofeedback and some medications can improve these problems. Treatment of prostate disease can also help decrease infection risk. Improvement in bladder function may help decrease the frequency of urinary tract infections.
Can anything be done about infections due to chronic diseases?
The best prevention for infections complicating diseases such as diabetes, circulatory diseases, and neurological conditions is to practice the preventive measures known to decrease the risk of these conditions. Careful attention to diet, exercise and weight control, and treatment of blood pressure and cholesterol can decrease the risk or seriousness of heart disease, blood vessel problems and obesity. Screening tests for breast, colon and prostate cancer are important for early diagnosis and treatment of these conditions. Advances in treatment for cancer and inflammatory conditions have both improved the outcomes from these diseases and given us a better ability to prevent infections associated with these treatments. Regular medical care should provide the elderly adult with access to the preventive vaccinations, screening tests and medical advice which are important in decreasing the risks of infections.
Dr. Paula Aucoin is a Consultant in Infectious Diseases and the Medical Director, Infection Control at Berkshire Medical Center.