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England’s chief medical officer says infections in older people should be taken “more seriously”.
professor sir chris whitty Saying older people are “underserved” when it comes to care and research for diseases affecting them, he said doctors should have a lower threshold for prescribing antibiotics than younger adults.
He suggested that the medical community has historically been “nihilistic” about infections in older people, adding that “people have assumed it’s just one of those things that happens in old age – in fact, there’s a lot we can do about it”.
The drug also urged older people to increase their protection against infection through measures such as washing hands, taking precautions when preparing food and accepting vaccinations offered on the NHS.
Data shows that people over the age of 70 are more likely to get infected, become seriously ill and die.
Discussing his new annual report, which focuses on infections, Sir Chris said: “While we are very systematic about reducing and preventing infections in children and young adults, in older adults it is often much more hit and miss.”
He said that, despite its importance, research on infection in older adults is “proportionally much smaller” than people expect.
Sir Chris told a briefing that deaths from the infection were “dominated by the elderly” and would become a bigger issue due to the aging population.
“As this population gets bigger, the amount of infections is going to increase if we don’t do something,” he said.
Looking at flu as an example, Sir Chris said, “The NHS will be under significant pressure over the next few weeks because flu is increasing rapidly, and it really affects the elderly”.
They also pointed to “clear evidence” that “having an infection increases the risk of stroke, especially in the first two weeks, but this may increase later for up to a year”.
Sir Chris said the risk of stroke is increased by “a whole range of infections”, including urinary tract infections, pneumonia, flu and HIV.
“There is less strong evidence that this is true for heart attacks,” he said, but he added that research shows people are more likely to have a heart attack in the days and weeks after infection.
The chief medical officer said, “What is the significance of this? Well, if we can reduce infections, we will reduce strokes and heart attacks, and I think certainly at this time, if someone has had a serious infection at an older age, we should consider modifying all the risk factors to reduce the risk of stroke and heart attack.”
Sir Chris said that infections can also cause delirium, adding that “For all these reasons, I think we should take infections in older people more seriously”.
Across populations, he said, doctors should be cautious about overprescribing antibiotics, which could lead to increasing drug resistance, where drugs no longer work against infections.
Sir Chris cautioned against using antibiotics when “someone almost certainly has a viral infection” for which they will not work, but added: “We should not be giving blanket rules for entire age groups.”
For example, in older people, the risk of infection turning into sepsis is much higher, he said.
“So the risk-benefit is more in favor of[antibiotic]treatment in older people than in younger people.”
Asked what actions people can take themselves, Sir Chris said: “There are a huge number of things older people can do to reduce the risk of infection. A lot of them are common sense.
“They are things like reducing the risks by washing hands, preparing food carefully – this is very important – and encouraging people who have recently had an infection not to visit them until they have been thoroughly cleaned.
“And then there’s vaccination.”
He said people should do as many things as possible to reduce their risk of stroke and heart attack, such as keeping their blood pressure low and quitting smoking.
The report also looked at vaccinations among children and pregnant women, as well as planning for future pandemics and threats.
“Vaccines are wonderful in childhood,” said Sir Chris, adding that when he was training in medicine, Haemophilus influenzae b (Hib) was a common cause of meningitis in children, but when a vaccine was introduced, cases dropped dramatically.
Speaking more generally about vaccines for children, he said, “They’re trending down a little bit, but they’re not falling off a cliff, as is sometimes said”.
Sir Chris said: “Some people who are keen to spread misinformation want to give the impression that Britain is becoming a vaccine-sceptic nation.
“This is absolutely not true.
“If you look at these numbers, more than 90 per cent of parents will bring their children for vaccination.
“But it has declined and we need to reverse it.
“The important thing is that a lot of it has to do with the practicalities of getting the vaccine.
“If you look exactly at why people are not getting vaccinated, it often has more to do with how easy it is to get it rather than any major change in people’s willingness to get vaccinated.”
She urged pregnant women to get a flu vaccine this winter and said that flu vaccination among pregnant women is “not as high as we would like”.
Sir Chris said: “It’s a real issue, because flu during pregnancy is a dangerous combination… so I would definitely encourage anyone who is pregnant to have a flu vaccine.
“It’s a very sensible thing to do, and we’re heading into a pretty tough flu season, so now is a good time to remind people of that.”