Kristin Casady, MA, Editorial Director, Geriatrics & Aging.

The association between low rates of adherence to medical treatments and poor health outcomes has been well documented, occurring even when the treatment under study was a placebo.1 Studies of adherence interventions should be of significant interest to those working with older adults, who are most likely to be on polypharmacy, yet such investigations are few when compared with the large number of trials for individual drugs and treatments.2 A recent issue of the British Medical Journal presents details of a study that investigated the effects of periodic telephone counselling by a pharmacist on medication compliance and mortality among community-dwelling patients on polypharmacy (>5 drugs).3

Roger E.Thomas,MD, Ph.D., CCFP, MRCGP, Professor, Department of Family Medicine, University of Calgary, and Cochrane Coordinator, University of Calgary, Calgary, AB.

Recent evidence has shown that vaccination against influenza is effective in reducing the complications of influenza (pneumonia, hospitalization for influenza or pneumonia, and deaths due to influenza or pneumonia) for those 60 years and over living in long-term care facilities (LTCs) during periods of high viral circulation if the vaccine has a good match to the circulating strain. Vaccination was found to be similarly effective for those 60 and over living in the community. There is further evidence that health care workers should be vaccinated for their own benefit, as vaccination is demonstrably effective for healthy adults under 60, and most health professionals are under 60.There is some evidence that vaccination of these workers may provide additional protection for residents of LTCs from the complications of influenza. Influenza can be detected by rapid office-based tests and should be used when the pretest probability of influenza is less than 30%. The evidence suggests that oseltamivir and zanamivir are effective in reducing the symptoms of cases and reducing infections in households and contacts of cases.
Keywords: influenza, older adults, vaccination, prevention of influenza, antivirals.

Janet E. McElhaney, MD, FRCPC, FACP, Geriatrician, Center for Immunotherapy of Cancer and Infectious Diseases and UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA.

Influenza is a serious illness and is probably the single cause of excess mortality during the winter months in the portion of the population that is aged 65 and over. In spite of its limited efficacy in older adults, influenza vaccination is a cost-saving medical intervention that can help to prevent pneumonias, exacerbations of heart failure, and, surprisingly, heart attacks and strokes. As hospitalization rates for acute respiratory illnesses continue to rise in spite of widespread vaccination programs, antiviral drugs need to be incorporated into prophylaxis and early treatment strategies for influenza. Particularly in the institutional setting, seasonal prophylaxis or influenza outbreak control that involves the staff is essential.

Key words: influenza, antiviral drugs, vaccination, prophylaxis, drug resistance.