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A Guide to the Seasonal Flu for Seniors
Updated on: October 2022
Reviewed by: Nancy Leahy, RN, APNP
When fall rolls around, the weather begins to change, you start to get in the holiday spirit, and… almost everyone gets sick? This isn’t a coincidence. The colder weather coincides with the beginning of flu season—a time when flu diagnoses begin to accelerate. It’s important to pay attention to symptoms of seasonal flu for seniors during this time as they can be more serious.
While the flu shares symptoms with the common cold—sore throat, cough, and a runny nose—the flu can result in far more devastating consequences. This is especially true among seniors, who can experience hospitalization or even death. Between 2010 and 2019, 336,000 people died of the flu, according to the Centers for Disease Control and Prevention, and as bad as that statistic is, it gets worse: fully 90% of the deaths from the flu in 2017-18 were adults over 65.
But thanks to vaccines and other approaches, seasonal flu for seniors is preventable. So let’s discuss exactly what the flu is, what it looks like, how it spreads, and how seniors can protect themselves from the virus.
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What is the Flu?
The “flu” is actually short for the illness’s proper name: influenza. Influenza is a respiratory illness that can onset mildly or severely and can result in hospitalization or death. The seasonal flu for seniors is caused by the influenza virus, which can infect humans and almost every other mammal and bird on the planet. This allows it to spread across the world with relative ease.
There are three main types of influenza viruses:
This is the most common type of influenza; it causes basically all of the flu epidemics (localized outbreaks of a disease) and pandemics (global outbreaks of a disease) around the world. This version of influenza can infect humans and animals (like pigs), and it is often found in wild birds as well, which carry the disease across continents. Influenza A has caused many of the flu pandemics in the 20th and 21st centuries.
Along with influenza A, influenza B, which lies behind about 20 percent of flu infections, causes almost all cases of the flu every year. This strand only survives in humans (and seals), so it is passed along among us homo sapiens.
The mildest of the three main forms of influenza viruses, influenza C is passed around among humans and swine. No epidemics are caused by influenza C, which explains why it’s not prevented with a flu vaccine.
Once contracted, the flu affects your nose, throat, and occasionally dives down into your lungs.
No matter the type of influenza virus you contract, the symptoms are pretty similar—though they vary in severity. Symptoms of the flu include
- Constant cough
- Runny nose
- Fever (for seniors, a body temperature above 101 degrees Fahrenheit), though this may not always occur
- Sore throat
- Muscle cramps or aches
- Stomach issues that may result in diarrhea or vomiting
You May Just Have the Cold
Just because you have these symptoms does not mean you have the flu. You may be suffering from the common cold, which has similar symptoms, but is far less fatal and severe. Typically, the common cold doesn’t get more severe than a stuffy nose and a light fever. It usually only lasts a few days, too. Any symptoms more severe than that (persistent headaches, vomiting, etc.) or lasting longer than two to three days should be treated immediately, as you may have the flu.
Complications from the Flu
Typically, with proper treatment, the flu lasts in your system for about two weeks. Seniors (people over the age of 65) are at a higher risk than many other demographic groups of suffering complications from the flu, and many of these complications can last even after your immune system has taken care of the influenza virus in your system. Seasonal flu for seniors can be more impactful for those who have:
- Kidney problems
- Heart problems
- Chronic lung disease
- An illness that causes them to take steroids or other medication like chemotherapy that weaken the immune system
- Liver problems
- Obesity issues
All of these medical issues can leave seniors open to the more severe effects of the flu—long hospitalizations and death—because they assist in weakening your immune system. Some other extended issues caused by seasonal flu for seniors include:
Pneumonia is a respiratory illness featuring chest pain, coughs, shaking and sweating, and body temperatures lower than normal that can progress after having the flu. It’s the fourth leading killer among seniors, who may be able to prevent the disease post-influenza with a pneumonia vaccine. Seniors are at a greater risk of developing pneumonia and dying from it than any other demographic.
Bronchitis is an inflammation of the lungs that is caused by having a respiratory issue like the flu. Its main symptom is a cough driven by lung irritation and mucus. Like influenza, some form of bronchitis can work through the system in two to three weeks, but there are some forms (chronic bronchitis) that keep coming back, even when the flu has long passed through your system.
Sinus and ear infections
Having the flu can make the body susceptible to infections from various bacteria in various parts of the body, including your sinuses and ears. If you have the flu and start experiencing ear pain that lasts longer than a day or two or sinus issues (more than just sneezing) that last longer than two or three days, you should seek additional professional help for these newfound medical issues.
Dehydration is a severe issue among the elderly, especially when they’re sick. Seniors have less water (10 to 15 percent less) in their bodies than when they were younger, allowing dehydration to onset pretty quickly, which is why it’s so important to consistently drink fluids while sick. Many symptoms of the flu, like sweating, a runny nose, and vomiting, cause water to drain out of your body and can cause you to quickly become dehydrated. Dehydration can result in kidney problems, seizures, and other potentially fatal medical issues.
Heart issues like heart attacks have been shown to happen more frequently after having the flu, according to the British Heart Foundation. Like sinus and ear infections, heart issues can stem from your body becoming more vulnerable to bacteria and other harmful substances affecting your heart. There are also medications that help get rid of the flu that can potentially cause blood clots, which can lead to further heart issues.
Causes of the Flu and How it Spreads
We know that the flu is caused by various influenza virus strains, but how you contract the virus differs per case.
The flu is highly contagious. The CDC says that one person can infect another if they are within six feet of each other. Some ways to come in contact with the disease include:
- Breathing the virus in
- Touching Doorknobs and handles previously touched by someone with the flu
- Coming in contact with unclean silverware
The virus is spread through small droplets of fluid created from coughs, sneezes, and saliva exiting your mouth while talking. Someone with the flu—who may not know it yet because they haven’t experienced symptoms—can infect someone else with the virus up to a day before they start showing symptoms. Symptoms may take up to four days to show after entering your system. Typically, you are contagious for another five to seven days after showing symptoms.
The flu has the potential of causing an epidemic, which is an outbreak of a virus in one section or community of the world. Because it’s possible for birds to carry the disease elsewhere, the flu can reach the worldwide population and cause a pandemic.
In 1918, the worst recorded influenza pandemic occurred when the H1N1 influenza A strain killed somewhere between 50 million and 100 million people (up to five percent of the world population at the time). The most recent flu pandemic occurred in 2009, when close to 20,000 people died around the world due to another H1N1 strain. While almost all influenza A strains are covered under vaccines, there are times when a strain that isn’t affected by the flu vaccine surfaces and causes worldwide hospitalizations and harm.
When is Flu Season?
There is no specific day when to mark when the flu season begins. The starting point of flu season varies every year depending on the location around the world and when the influenza virus reaches certain communities and countries.
The start of flu season is marked by whenever levels of influenza infections start to rise above normal levels. In the United States, this increase in flu infections usually happens between the fall and spring months, with peaks in January and February. The length of the flu season can also vary depending on if a certain strain of influenza reaches pandemic levels, which can extend a season to longer than a year as a vaccine is developed and distributed.
From the end of 2011 to 2019, the flu seasons in the United States have lasted from (via CDC):
- October 2, 2011 to May 19, 2012
- September 30, 2012 to May 18, 2013
- September 29, 2013 to May 17, 2014
- September 28, 2014 to May 23, 2015
- October 4, 2015 to May 21, 2016
- October 2, 2016 to May 18, 2017
- October 1, 2017 to May 19, 2018
- September 30, 2018 to May 18, 2019
While the start and end dates of flu seasons don’t fluctuate too widely, there’s still no specific day in the fall when you should become more wary of catching the flu and no specific day in the spring when worries should lessen. In fact, the 2018-19 flu season was the longest in a decade, clocking in at 21 weeks.
But the length of a flu season only tells half the story. The other half is the intensity of the season, as measured by rates of doctor visits, hospitalization, and death. The 2017-18 flu season, for example, was particularly bad: at one point during that season, nearly one out of ten deaths in the US was caused by the flu. Regardless of the year, however, one trend stands out: over the past 16 years, more than a quarter of flu seasons have resulted in higher-than-usual rates of seasonal flu for seniors compared to the general population.
How to Find Out if You Have the Flu
It’s possible to be sick during flu season while not being vaccinated, but that doesn’t always mean you have the flu—you may just have the common cold. But if flu symptoms last more than a two days, you should get tested by a doctor immediately, as the common cold and the flu are treated with different levels of medication because the flu is so much more severe.
There are different tests with varying levels of accuracy that health care professionals can conduct to figure out if you have the flu. These can include:
Rapid Influenza Diagnostic Test (RIDT)
This is the most common flu test, but it’s also the least accurate. The CDC says this type of test aims to detect the influenza virus that triggers an immune response in your body. “Rapid” is in the test’s name because results can be seen in about 15 minutes. Your doctor simply has to rub a cotton swab inside your nose or on the back of the throat to collect a sample.
Rapid Molecular Assays
More accurate than RIDTs, rapid molecular assays for influenza search for the genetic makeup for the influenza virus. Like RIDTs, a sample is retrieved simply by swabbing the inside of your nose or the back of your throat, and results come pretty quickly (less than 20 minutes).
This is where tests start to get even more accurate, but they also take longer to yield results and are more expensive to conduct. This test, which detects the antigens of the influenza virus, is conducted with a fluorescent microscope, and it takes a couple hours to provide results. The World Health Organization says that this test should be used to confirm a result of a rapid flu test in periods of low influenza diagnosis (non-flu season).
Analyzing the Cell Culture
There are two types of tests that analyze the cell cultures of samples: rapid tests and viral tissue tests. They both take anywhere from a couple days to more than a week to get results. These help doctors confirm that the type of influenza being treated is one that’s been seen before and is covered by the vaccine. If a new strand of influenza A or B is detected, there is potential for an epidemic or pandemic, and it must be addressed in the newest vaccine developed.
You may not always be tested for the flu, because the general, more severe symptoms of the flu (bad cough, chills, and headache) will be treated similarly with or without a confirmed diagnosis. In either situation, during flu season, the WHO suggests doctors use one of the rapid tests to confirm a diagnosis before any other test in order to get the virus under control as quick as possible.
Why Senior Should Consider Vaccination
Seniors are the demographic group most affected by the flu. The CDC reports that between 70 and 85 percent of people who die from seasonal flu infections are over the age of 65, and that up to 70 percent of flu-related hospitalizations involve seniors. These are staggeringly high rates, and they can be directly connected to how often seniors get vaccinated, in addition to seniors’ weakened immune systems making them especially vulnerable to the flu.
Getting vaccinated helps, too. The CDC found in 2016 that seniors getting the flu vaccine—which covers most strains of influenza A and B—reduced the likelihood they’d be hospitalized because of the flu by more than 50 percent. Vaccinated people over the age of 50 were found to be 57 percent less likely to be hospitalized from the flu than non-vaccinated people. The hospitalization rates were similar for people over the age of 75, as well.
Older adults should also get vaccinated because they can contract the flu without obvious symptoms. According to a 2019 CDC study, symptoms that people commonly associate with the flu (like fevers or congestion) tend to show up less frequently among older adults than in the general population. On the other hand, less obvious (but still dangerous) symptoms like a loss of mental clarity, are more frequent among seniors. What’s more, someone who doesn’t realize they’re infected can’t know that they’re contagious, making them a danger to the people around them. If you or the senior in your life are avoiding getting vaccinated because you expect to simply treat the flu if you get sick, you may be taking a much bigger risk than you realize.
Despite how effective the flu vaccine can be, about one-third of seniors still don’t get vaccinated. Rates have hovered around this number for the last 15 years, and the government aims to increase senior flu vaccination rates to 90 percent by 2020. “It’s amazing how once people see the disease up close, getting the vaccine suddenly raises up on their list of priorities,” said Dr. Robert Wergin, a Nebraska physician and president of the American Academy of Family Physicians. This is why it’s important to get ahead of the flu with a vaccination. It’s not worth the risk.
How and Where to Get Vaccinated
While most adults are fine with receiving a standard-dose flu shot, seniors may need vaccines that are tailored to their immune systems:
High-Dose Flu Shots
Seniors need a higher dose of the flu vaccine because of their weakened immune systems. The shot also features higher levels of antigens—antibodies that activate an immune response—to help your body combat the flu should it enter your system.
Flu Shots With Adjuvant
Adjuvant, according to the CDC, is “an ingredient added to a vaccine that helps create a stronger immune response to vaccination.” These types of flu shots were found to be far more effective at helping seniors create an immune response to the flu than shots without adjuvant.
While these shots may be tailored for seniors, the CDC says there is no specific recommendation for which shot seniors should take, whether it be the high-dose shot, the option with adjuvant, or a regular-dose option. There are other types of vaccines, including a nasal spray and an intradermal shot, which are not recommended.
Any doctor or health care professional should be able to distribute the flu vaccine. Some places you can get a flu shot include:
- A doctor’s office
- A pharmacy like CVS, Walgreens, or Rite-Aid
- A blood-testing lab
Flu vaccines should be covered by your insurance and Medicare. Under the Affordable Care Act, private insurers must cover preventative care like flu shots. Flu shots are also covered under the Medicare B provision. As long as your doctor doesn’t charge more than Medicare covers, the shot should be completely free.
Possible Side Effects of Vaccination
After getting the shot, you may feel mild or moderate pain where the vaccine was injected. There is also the potential—albeit pretty rare—that you will get a fever as a result of the shot. This does not mean you have the flu, and the fever will subside. Other rare, but noteworthy, side effects include:
- Allergic reactions
- Problems breathing
- An increased heart rate
You will not get the flu from receiving the flu vaccine.
Should Anyone Not Get Vaccinated?
The CDC recommends that every senior physically capable of getting the flu shot should get one, except for those who:
- Have had allergic reactions to the shot in the past
- Have a high fever, though it’s suggested they get one once the fever subsides
Seniors with allergies to eggs are still recommended to get the vaccine, even though many flu vaccines contain an egg protein called ovalbumin. Doctors are suggested to watch the patient for 30 minutes to see if the shot causes any allergic reactions, but after that time period, the person with the allergy receiving the shot should be clear of any allergic reactions.
How to Prevent the Flu
The best way to prevent getting the flu is by getting the vaccines, even though only about 60 percent of vaccinations are effective, according to NPR. There are plenty of other preventative steps seniors can take in order to reduce their chances of catching the influenza virus. These steps include:
Lead a healthy lifestyle
As we’ve seen, seniors’ immune systems become less effective as they age. There are things to be done to help combat that, though, including eating properly and exercising. Beyond that, there are day-to-day activities like being consistent with your hand washing and keeping a clean and sanitized living space that can help kill viruses and stop the spreading of the disease.
Get other vaccines
The flu vaccine certainly helps prevent getting the flu, but what if you actually get it? There are a slew of other health concerns that can develop after catching the influenza virus. There are various vaccines you can get to help prevent these advanced issues, which can include pneumonia and meningitis.
Seek immediate help if you’re feeling ill
Not only does this help you address immediate health concerns—whether they end up being the flu or not—it also helps you know if you’re contagious so you can take preventative steps from spreading the virus. You can call out of work, sanitize your living space where other people may come in contact with the virus, and make sure you drink extra fluids to stay hydrated.
The flu is serious business. If you have any other questions about the virus and how to prevent it, talk with your primary care physician.