Underdiagnosis of Influenza Virus Infection in Hospitalized Older Adults

Underdiagnosis of Influenza Virus Infection in Hospitalized Older Adults Infections caused by influenza virus are associated with substantial morbidity and mortality in all age groups, with the highest rates of hospitalization and death in older adults. Prompt recognition, diagnosis, and treatment is predicated upon a suitable case definition of influenza‐like illness (ILI), conventionally defined by the Centers for Disease Control and Prevention as fever (temperature ≥ 37.8°C) and cough or sore throat, but this definition has several limitations in older adults because of comorbid conditions and immunosenescence (aging of the immune system). Adults aged 65 and older may have an attenuated febrile response, possibly due to altered thermoregulatory responses or lower baseline core body temperatures, leading some to suggest revised criteria with a lower fever threshold for suspicion in older adults with suspected influenza. Cognitive deficits that limit ability to communicate symptoms and exacerbations of chronic conditions, particularly cardiac and pulmonary disease, that may dominate clinical presentation may further complicate recognition of influenza in older adults. The effect of these differences on provider‐ordered influenza testing is not well known.We examined the demographic and clinical characteristics of inpatients who underwent provider‐ordered influenza testing and compared them with those who were not tested to examine what factors influence influenza testing. Because all http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of American Geriatrics Society Wiley

Underdiagnosis of Influenza Virus Infection in Hospitalized Older Adults

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 American Geriatrics Society and Wiley Periodicals, Inc.
ISSN
0002-8614
eISSN
1532-5415
D.O.I.
10.1111/jgs.15298
Publisher site
See Article on Publisher Site

Abstract

Infections caused by influenza virus are associated with substantial morbidity and mortality in all age groups, with the highest rates of hospitalization and death in older adults. Prompt recognition, diagnosis, and treatment is predicated upon a suitable case definition of influenza‐like illness (ILI), conventionally defined by the Centers for Disease Control and Prevention as fever (temperature ≥ 37.8°C) and cough or sore throat, but this definition has several limitations in older adults because of comorbid conditions and immunosenescence (aging of the immune system). Adults aged 65 and older may have an attenuated febrile response, possibly due to altered thermoregulatory responses or lower baseline core body temperatures, leading some to suggest revised criteria with a lower fever threshold for suspicion in older adults with suspected influenza. Cognitive deficits that limit ability to communicate symptoms and exacerbations of chronic conditions, particularly cardiac and pulmonary disease, that may dominate clinical presentation may further complicate recognition of influenza in older adults. The effect of these differences on provider‐ordered influenza testing is not well known.We examined the demographic and clinical characteristics of inpatients who underwent provider‐ordered influenza testing and compared them with those who were not tested to examine what factors influence influenza testing. Because all

Journal

Journal of American Geriatrics SocietyWiley

Published: Jan 1, 2018

Keywords: ; ;

References

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