Up to 1.6 million people were sickened with influenza from Oct 1. through Nov. 11, the Centers for Disease Control and Prevention said Friday.

The agency published preliminary estimates based on data collected through the Influenza Hospitalization Surveillance Network, or FluSurv-NET. The overall range of illnesses during the specified time period was estimated to be 780,000 to 1.6 million.

The flu also resulted in 360,000 to 770,000 medical visits, 8,000 to 17,000 hospitalizations and 490 to 1,500 deaths, the CDC said.

Residents of long-term care facilities, adults aged 65 or more years and adults with chronic conditions — such as diabetes, asthma, heart disease or stroke — are among the populations most at risk for complications stemming from the flu. “In recent years, for example, it’s estimated that between 70% and 85% of seasonal flu-related deaths have occurred in people 65 years and older, and between 50% and 70% of seasonal flu-related hospitalizations have occurred among people in this age group,” the agency said in a website post.

A flu vaccine is the best way to protect against flu and its potentially serious complications, the CDC said, noting that people aged 65 or more years and older should get one of three higher-dose or adjuvanted flu vaccines available — including Fluzone High-Dose Quadrivalent, Flublok Quadrivalent or Fluad Quadrivalent — because such vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.

Health officials recommend vaccination for long-term workers as well.

All flu vaccines for the 2023-2024 season are quadrivalent vaccines (protecting against four different flu viruses), but in the future, flu vaccines will go back to being trivalent (protecting against three different flu viruses), according to the CDC.

“Regulatory agencies have recommended that B/Yamagata lineage vaccine viruses be removed from flu vaccines in the future because these viruses have not been detected and, as a result, no human infections with it have been identified since March 2020,” the agency said.

By analyzing older adults’ patterns of sleep and exercise, data collected from wearable devices could help demonstrate a risk of frailty more than six years before its onset, a new study shows.

“Our study demonstrates that wearable devices could represent an important tool for long-term health monitoring in older adults,” study lead author Ruixue Cai said in a statement. “Frailty can reduce quality of life and detecting it early or predicting who is at risk could help us intervene to promote healthy aging.”

Although less ominous-sounding than Alzheimer’s or Parkinson’s, frailty is a major concern among senior living and care residents and can lead to a variety of complications, from weight loss to a heightened risk of more fatal diseases. 

Up to 90% of nursing home residents already are frail or are considered to be in a pre-frail state, according to one review.

The study on wearables was conducted at Brigham and Women’s Hospital in Boston and involved more than 1,000 participants whose collective mean age was 81; the cycle of sleep and wakefulness the wearables are designed to track is defined in the research as “circadian rest-activity rhythm.” 

Maintaining healthy patterns of sleep — and better quality of sleep — is very important for older adults’ quality of life; some senior living and care operators have smart lighting systems installed to help address this concern. 

Due to the more nebulous nature of a frailty diagnosis, a recent study recommended a new frailty “score” that evaluates the condition along a spectrum, rather than suggesting an older adult either is “frail” or “not frail,” the McKnight’s Clinical Daily reported last month.

The investigation took place in Ontario, Canada, in facilities participating in the Communication at End-of-Life Program between August 2019 and March 2020. The program seeks to improve LTC staff members’ competencies in providing palliative care and end-of-life care to residents and their families.

The researchers sought to capture staff members’ confidence level in their skills and knowledge, their attitudes toward death and dying, relationships with residents and families and level of participation in care. They also identified facilitators and barriers to providing care during the pandemic. 

Nineteen staff members responded to the survey, 28 participated in semi-structured interviews, and 8 participated in both. Participants represented a variety of positions, including personal support workers, nurses, and allied healthcare staff and administrators.

Challenges, despite training

Study participants expressed having notable challenges that were “severe and negative,” despite being palliative care leaders and champions within their facilities and receiving added training in palliative and end-of-life communications through the CEoL Education Program.

Issues that impinged on confidence and care delivery competency included visitation restrictions, staffing shortages, added workload and psychological stress, lead author Annie H. Sun, MPH, of the Bruyère Research Institute, Ottawa, Ontario, reported. 

“Participants reported notable deterioration in confidence and comfort in care delivery, as well as challenges in providing patient-centered palliative and end-of-life care during the pandemic,” Sun reported.

Top challenges

Visitation restriction resulted in residents feeling lonely and isolated, and impeded staff members’ abilities to build supportive relationships with families, she noted. Single-site work restriction implemented by Canada’s provincial governments and the increase in illness increased workload. Staff and residents also contended with psychological stress caused by  fear of COVID-19 infection and transmission, hindering care provision.

Maintaining confidence

Despite these struggles, 90% of study participants reported that they were able to maintain a high level of confidence and meet residents’ end-of-life needs. And nearly half of the interview participants said that support from co-workers and management remained consistent. More frequent discussions about residents’ goals of care necessitated by pandemic circumstances helped raise confidence as well, they reported.

Reducing burnout

Although the study sample was small, and therefore not fully generalizable, the results highlight the critical importance of psychological support needed to reduce the level of burnout among health and social care workers, Sun and colleagues said.

“Our findings emphasize the importance of providing ongoing psychosocial support to staff in their recovery in the post-pandemic period and beyond,” the researchers concluded.

Full findings, including more details of specific care challenges, were published in JAMDA.

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Investigators examined data on filled prescriptions that included a 20% sample of Medicare Part D data from 2013 to 2017 and a 40% sample from 2018. Beneficiaries included Medicare beneficiaries aged 66 years or older who were enrolled in Medicare Advantage or traditional Medicare Part D plans.

The researchers looked for the number of unique HRMs prescribed per 1000 older Medicare beneficiaries. Results were adjusted for patient and county characteristics and hospital referral region.

Continued improvements

The results showed a continuation of improvements also observed earlier, between 2007 and 2011, the researchers reported. The number of HRM prescriptions received by older Medicare beneficiaries decreased from 2013 to 2018. In addition, the rate of HRM use among Medicare Advantage beneficiaries was consistently lower than those in traditional Medicare, although the gap has narrowed over time, lead author Jose F. Figueroa, MD, MPH, of the Harvard T.H. Chan School of Public Health in Boston reported.

Notably, certain groups had the highest use of HRMs. These included female, American Indian or Alaska Native and non-Hispanic White populations.

The decline in HRM use across both traditional Medicare and Medicare Advantage is reassuring, the researchers wrote. But “higher rates of filled HRMs among the traditional Medicare, American Indian or Alaska Native, White, and female populations compared with their counterparts warrant further attention,” they concluded.

Full findings were published in JAMA Network Open. 

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The findings reveal the need to recognize TBI as a chronic condition and underscore the importance of providing care that supports these patients’ changing needs, researcher Benjamin Brett, PhD, of the Medical College of Wisconsin in Milwaukee said.

The study examined outcomes in more than 1,200 patients at 18 level 1 trauma centers. Patients with mild and moderate to severe TBI were matched to patients without head injuries and were followed for up to seven years.

Patient improvement, and decline

Patients continued to show improvement and decline across a range of areas over the study period, the researchers found.

The combined results of test scores for cognition and daily functioning showed that 21% of patients with mild TBI experienced declines. This was compared with declines seen in 26% of patients who had moderate to severe TBI and 15% of patients with orthopedic injuries and no head injury.

Most long-term decline was in activities of daily living (ADL) functioning. Over 2 to 7 years after their injuries, 29% of those with mild TBI and 23% of those with moderate to severe TBI experienced ADL declines.

Meanwhile, other patients showed ADL improvements, including 22% of those with mild TBI improving and 36% of those with moderate to severe TBI.

Emphasis on supports

“Our results dispute the notion that TBI is a one-time event with a stagnant outcome after a short period of recovery,” Brett said. He recommends that clinicians keep this in mind when caring for patients with these injuries.

Care for people with TBI “should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline,” Brett said in a statement.

Missed symptoms in older adults

Senior adults have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths in the United States, and falls are the leading cause of TBI-related deaths among women aged 75 years and older and men aged 85 years of age and older.

There is a relatively higher risk for missed symptoms or misdiagnosis among older adults as well, according to the Centers for Disease Control and Prevention. Signs of TBI overlap with other common medical conditions in this age group, such as dementia, potentially obscuring TBI-related symptoms, the agency says. 

Health officials recommend that clinicians check for TBI if an older adult has fallen or has a fall-related injury, or has been in a car crash. Clinicians should also note that older adults who are taking blood thinners are at particular risk for severe injury or death due after TBI to a higher risk of brain bleeds.

The study was published in the online issue of Neurology.

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The agency announced the decision on Thursday, following a recommendation by its expert advisers, who recommended the vaccines be indicated for adults aged 60 years and older after consultation with their doctors. The shots, made by Pfizer and GSK, are the first to be licensed in the United States to protect against RSV, CDC said.

The sign-off is the last step on the path to commercial rollout following earlier approval by the Food and Drug Administration, and the vaccines are expected to become available in the fall.

RSV severely sickens up to 160,000 U.S. seniors each year. Some 10,000 older adults die annually from the infection, the CDC reported. The people most likely to experience severe RSV illness and hospitalization include older adults with chronic heart or lung disease and weakened immune systems and those living in nursing homes or long-term care facilities, it noted.

Anticipating fall virus season

“For the first time in U.S. history, people 60 years and older can now receive a vaccine for protection against the RSV virus,” Xavier Becerra, secretary of the Department of Health and Human Services (HHS), said in a statement following the CDC announcement. The decision to endorse the vaccines ensures that at-risk adults have strong protection against circulating respiratory viruses, he said. 

“As we prepare for the fall vaccine campaign, we will follow the data and science to protect our nation’s most vulnerable older adults, those living in nursing or long-term care facilities, and the immunocompromised,” he said. 

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The Gates Foundation on Wednesday disclosed that it would fund the trial, according to medical news outlet STAT. 

The new trial aims to reveal whether the vaccine can prevent illness in adults and adolescents who have latent infections (infections with no symptoms). This stands in contrast to the older medication, called the BCG vaccine, which is designed and used to prevent active TB in children, STAT reported.

The new clinical trial has a global focus, as worldwide TB mortality is about 1.6 million people each year, STAT noted. But TB affects vulnerable groups in the United States population and is a problem for many residents of U.S. nursing home facilities. In fact, the news follows a recent recommendation by the U.S. Preventive Services Task Force that clinicians screen for latent tuberculosis infection in at-risk adults aged 18 years and older, including those living in congregate settings.

The task force recommendation did not explicitly mention the nursing home population among high-risk groups, but long-term care facilities are generally considered high-risk congregate settings. And in an unrelated 2019 study, researchers noted that “despite advances in diagnosis and treatment, the rate of TB is four times higher in residents of nursing homes than in the general population.” 

If left untreated, tuberculosis can be life-threatening, and as a highly infectious disease can spread to other residents. Delayed or missed diagnoses could result in increased transmission.

The new Gates Foundation-funded clinical trial will be conducted across 50 sites in Africa and Asia and will likely take four to six years to complete, STAT reported.

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Investigators used data from more than 15,000 participants in the 2021 National Health Interview Survey to examine the odds of experiencing high-frequency levels of pain in the three months after a COVID-19 illness. Researchers compared the reports of patients who said they experienced no and/or mild symptoms and those reporting moderate and/or severe symptoms with people who were never infected.

Compared to the no-infection group, those with moderate/high COVID-19 symptoms were more likely to have pain, and 26% of patients with non-mild cases reported frequent pain, they found.

“A moderate/highly symptomatic COVID-19 infection may be a new risk factor for chronic pain,” the researchers wrote. The results suggest that the overall prevalence of COVID-19 related chronic pain may increase, they said, as the number of people who have experienced a severe COVID-19 infection continues to rise.

“While knowledge continues to unfold on long-haul [long COVID] symptoms, prevention of severe infections remains essential,” they concluded.

Full findings were published in PLOS ONE.

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