Take Good Care of Yourself

“Button up your overcoat
When the wind is free
Oh, take good care of yourself
You belong to me.” 

 Frank Sinatra, ‘Button Up Your Overcoat’

“Breath is the finest gift of nature. Be grateful for this wonderful gift.”

  Amit Ray

The new influenza season is officially upon us. Once again, thousands of Americans will die from flu related pneumonias over the next six to eight months… as surely as God made little green apples. The more is the pity, because the key to preventing many of these pending needless deaths is as elementary as… well, breathing.

Most of the unfortunates who shall die from influenza related pneumonias this season will be elderly, and most will not have been properly immunized against influenza and against pneumonia.

Seniors aged sixty five years and older historically immunize against influenza and pneumonia at dismally low rates as a group. Only one out of five seniors will voluntarily immunize themselves this year. From another perspective, four out of five seniors will be available to contract and carry influenza to share with vulnerable friends and family members; and with total strangers in numerous medical waiting rooms... and at local senior centers.

Vaccines against influenza and pneumonia are cost free to all seniors enrolled in Medicare, and for most seniors still covered by other credible insurance coverage. The availability of vaccines at a growing number of community pharmacies and community free clinics has made the immunization process in most states as trouble-free as scoring a Slurpee at the local 7-Eleven.

Cost and availability are in no way detractors preventing seniors from immunizing. The culprit variables might instead be as simple as unfounded fears about vaccinations, lack of education about vaccinations, or individual armchair- inertia. These mountains just won’t come to the immunizing pharmacists, so to speak... so we must go to them.

If pharmacists and other immunizers fail to actively reach out to these at-risk patients by mail, by telephone, via sneaker-net, or even by pleading-on-bended-knee… pathologically bad things will happen. Guaranteed.

Eight percent of this entire herd will eventually die from influenza related pneumonias. One out of ten visits to the emergency room for flu related pneumonias from this group will end in death. Two out of ten emergency room visits will result in multiple Medicare-readmissions-within-thirty-days… that will strain the finances of struggling hospitals. Escalating rates of bacterial resistance against antibiotics commonly used to treat pneumonias can only worsen this gloomy picture over time.

The following chart offers current federal recommendations for immunizing seniors against Influenza and Pneumonia:



The following general vaccine administration guidelines can be followed by immunizers when vaccinating at-risk elderly patients against influenza and pneumonia:

-Immunocompetent adults 19 to 64 years of age or older with diseases, habits, or living conditions that put them at high risk of pneumococcal disease: Heart disease (including heart failure or cardiomyopathy), Pulmonary disease (including COPD, emphysema, or asthma), Diabetes, Alcoholism, Cigarette smoking, Chronic liver disease, Long-term care facility residents:

   

 Annual Influenza Vaccine

 Single dose of Pneumococcal PolysaccharideVaccine                  (Pneumovax-23).

-Adults 65 years of age and older:

Annual Influenza Vaccine

Single dose of Pneumococcal Conjugate Vaccine (Prevnar 13) if not previously given, followed by Pneumococcal Polysaccharide Vaccine (Pneumovax 23) six to 12 months later.

• Wait until at least one year has passed since any previous Pneumococcal Polysaccharide Vaccine (Pneumovax 23) dose to give Pneumococcal Conjugate Vaccine (Prevnar 13).

• Those who received one or more doses of the Pneumococcal Polysaccharide Vaccine (Pneumovax-23) before age 65 for any indication should receive another dose at age 65 or older if five years have elapsed since their previous Pneumovax-23 dose.

Note that giving both vaccines to today’s seniors is estimated to prevent 230 cases of invasive pneumococcal disease and 12,000 cases of community-acquired pneumonia over their lifetime.  Referenced: “Pneumococcal Vaccination in Adults: Who Gets What and When?” Pharmacists Letter/Prescribers Letter, November 2014.

Immunizing pharmacists are uniquely positioned in most communities to perform the aggressive outreach necessary to educate at-risk seniors about, and to immunize vulnerable seniors against, influenza and pneumonia. The “main street” nature that is so integral to the practice of community pharmacy makes immunizing pharmacists a logical choice among health providers to lead a grassroots immunization campaign.

Absent such aggressive clinical actions, many of these patients will not live to see the start of another flu season. These older folks are our loved ones, our family, our friends, our neighbors, our patients. The best tune for seniors this flu season has a simple chorus to croon:  take good care of yourselves… you belong to us.

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