Caregiver instructing older woman about taking medication

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The key to avoiding a “twindemic” of COVID-19 and influenza in senior living and other congregate care settings is for operators to adopt a “not on my watch” attitude toward illness by stressing the importance of vaccination with residents and staff members, according to a national public health expert.

Influenza complications — namely pneumonia and death — make it especially important for long-term care workers and residents to get vaccinated against the flu, National Foundation for Infectious Diseases Medical Director William Schaffner, M.D, told McKnight’s Senior Living.

“It’s clear that caregivers are the major way influenza is introduced into long-term care facilities,” Schaffner said. “It’s important for both caregivers and residents to be vaccinated for their own protection — particularly from the point of view of caregivers, so they don’t give influenza to the patients. They are healthcare providers.”

Although Schaffner said it’s too early for national flu vaccine data to be available for the current flu season, he said he’s concerned that influenza vaccinations are lagging. According to an NFID survey, only 45% of U.S. adults with chronic health conditions were vaccinated against influenza by early November. The reason? They said their healthcare providers never advised them that flu puts them at increased risk for serious disease complications.

The results of two national NFID surveys on attitudes and practices toward flu vaccination released Monday reveal a disconnect between patients and healthcare professionals, potentially putting individuals with heart disease, lung disease, diabetes and other chronic health conditions at risk.

“Even when their condition is well-controlled, people with heart disease, lung disease or diabetes are at increased risk for serious flu-related complications, including hospitalization and death,” Schaffner said. “In fact, during recent flu seasons, nine out of 10 people hospitalized with flu had at least one underlying health condition.”

With so much COVID and COVID vaccine fatigue, Schaffner said, he’s had to reintroduce the concept of flu as “that other bad guy” and double back on promoting the importance of flu vaccinations.

As with COVID-19, Schaffner said it’s important for senior living operators to continue to educate, answer questions and provide reassurances to residents and staff members about the importance of flu vaccines. He called it an “ethical and professional responsibility” to avoid introducing influenza into their communities or taking the virus home to families.

“You really have to put in the effort, be determined, decide it’s important and that you don’t want an outbreak of flu in your facility,” Schaffner said.

At the beginning of this year’s flu season, Schaffner said, the influenza A (H3N2) strain has been detected, placing more emphasis on the importance of vaccination. In past flu seasons, this strain led to more serious disease, particularly among older adults.

The survey findings, he said, reinforce the importance of healthcare professionals having conversations with adults who have chronic health conditions about the importance of flu vaccination.

The NFID reports that 51% of patients who plan to receive a flu vaccine said that a healthcare professional’s recommendation motivated them to do so; 26% who were unsure about getting vaccinated or decided against vaccination said at least part of the reason was that it was not recommended by a healthcare provider.

Almost two-thirds (63%) of people with chronic health conditions said they were advised by a medical professional to get vaccinated against pneumococcal disease, and 49% said they had done so.

The NFID Healthcare Professionals Survey was conducted online among 400 endocrinologists, primary care physicians, cardiologists and pulmonologists from Oct. 28 to Nov. 8. The NFID Adult Patient Survey was conducted online during the same timeframe among 300 patients treated for diabetes; chronic lung conditions, including chronic obstructive pulmonary disease or asthma; or cardiovascular conditions, including heart attack, heart disease and heart failure.