Educating Patients About H1N1


Barney S. Spivack, MD, FACP, AGSF, CMD
Associate Physician Editor, Clinical Geriatrics


Pages 7 - 8

The 2009 H1N1 virus (“swine flu”) may be back in force earlier this fall than the seasonal flu, the Centers for Disease Control and Prevention (CDC) reported in mid-summer, as this issue of Clinical Geriatrics went to press.

Though the summer is usually flu-free, the new virus was continuing to cause illness, hospitalizations, and deaths in the United States throughout the summer months, and the World Health Organization (WHO) declared a worldwide pandemic. In light of this, the CDC warned that we could well see increases in H1N1 cases starting in September—when children head back to school—rather than in October or November, when seasonal flu cases typically begin to rise.

In early August, clinical trials with swine flu vaccinations still had several weeks to go and federal officials were unsure how many doses they might have by early September. The CDC, which plans to start immunization programs as soon as possible, was anticipating that it would have to triage the vaccinations. And the agency’s Advisory Committee on Immunization Practices (ACIP) was recommending that the following higher-risk individuals get vaccinated first: pregnant women, those caring for children younger than 6 months, healthcare and emergency medical workers, those age 6 months through 24 years, and those age 25 through 64 years who have health problems associated with increased risks of complications.

Current research suggests that healthy adults who are 65 years and older run lower risks of infection with the H1N1 virus than the aforementioned groups. A possible explanation is that older adults may be better protected against H1N1 due to previous antigenic exposure. Even so, once vaccine demand among younger age groups has been met, the ACIP recommends that vaccinations be offered to those age 65 or older. Older adults should also receive the seasonal flu vaccine, the panel notes.

Older patients are regularly advised to get the seasonal vaccine each fall. With the H1N1 virus making headlines on a regular basis, clinicians should be prepared to explain the “swine flu” vaccination protocol, as well as the seasonal flu vaccination need, to our older patients and their loved ones.

We will need to clarify that getting the seasonal flu vaccine is still essential, and that it protects against the flu, as does hand-washing and other well-proven hygienic and public health recommendations. We should also explain that healthy older adults appear to run lower risks from H1N1 infection than others and, for this reason, are not on the list of those who should be immunized against H1N1 first in case the supply of initial vaccine is limited. And we should add that while they may have to wait a bit before additional H1N1 vaccine is available, all older adults should get inoculated once it becomes available.

Needless to say, we should also encourage our older patients to keep current with all of their recommended immunizations. Recent CDC data indicate that far fewer older adults are getting vaccinated against common infectious diseases than recommended. Only 60% of adults age 65 and older get immunized against influenza and pneumococcal disease—far short of the target rate of 90%. Unfortunately, even fewer older adults get other recommended vaccines. Fewer than 7% of adults older than age 60 get the shingles vaccine, for example, despite its proven benefits. The high cost of some vaccines such as the shingles vaccine may be a factor. Reminding our older patients of the importance of regular immunizations, and sharing information regarding Medicare coverage of vaccines, can help. We can also provide direction to our staff and other health professionals in long-term care and other care environments, and “lead by example”—by getting the flu vaccine ourselves, as recommended for all healthcare professionals.

To further help older adults and their loved ones understand why and when to get vaccinated, the American Geriatrics Society’s (AGS) Foundation for Health in Aging (FHA) has published an easy-to-understand “tip sheet” about recommended immunizations. It is available at The FHA has also published a patient information sheet about the H1N1 virus, available at These information sheets, as with the others in the FHA’s series of elder health tip sheets—at—can be downloaded, printed, and shared with older adults and their families at no cost.

At LifeCare (, we have also been focusing on the need for workplace preparedness for an anticipated up-tick in H1N1 cases followed shortly by the arrival of seasonal flu. We’re fully aware that employees who are caregivers for children or older adults may be affected by school closures, as well as by health complications and other daily routine disruptions that may affect aging loved ones. Employers should begin planning efforts, if they haven’t already done so, that include employee education programs. The CDC’s “Plan and Prepare” campaign ( can help businesses as well as individuals take steps to limit the negative impact of anticipated outbreaks.

I encourage you to become familiar with these and other helpful resources made available through the AGS—and to visit for additional updated information.

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