MISCONCEPTIONS ABOUT FLU VACCINES

Can a flu vaccine give you flu?

No, flu vaccines cannot cause flu illness. Flu vaccines given with a needle (i.e., flu shots) are made with either inactivated (killed) viruses, or with only a single protein from the flu virus.  The nasal spray vaccine contains live viruses that are attenuated (weakened) so that they will not cause illness.

Are any of the available flu vaccines recommended over the others?

Yes, for some people. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant  flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. There is no preferential recommendation for people younger than 65 years.

What if a preferentially recommended flu vaccine is not available?

If none of the three flu vaccines preferentially recommended for people 65 years and older is available at the time of administration, people in this age group should get any other age-appropriate flu vaccine instead.

Is it better to get sick with flu than to get a flu vaccine?

No. Flu can be a serious disease, particularly among young children, older adults, and people with certain chronic health conditions, such as asthma, heart disease or diabetes. Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection.

Do I really need a flu vaccine every year?

Yes. CDC recommends a yearly flu vaccine for everyone 6 months of age and older with rare exception. The reason for this is that a person’s immune protection from vaccination declines over time, so an annual vaccination is needed to get the “optimal” or best protection against the flu. Additionally, flu viruses are constantly changing, so the vaccine composition is reviewed each year and updated as needed.

Why do some people not feel well after getting a seasonal flu vaccine?

Some people report having mild side effects after flu vaccination. The most common side effects from flu shots are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. If these reactions occur, they usually begin soon after vaccination and last 1-2 days.

Side effects from the nasal spray flu vaccine may include: runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat and cough. If these problems occur, they usually begin soon after vaccination and are mild and short-lived. The most common reactions people have to flu vaccines are considerably less severe than the symptoms caused by actual flu illness.

• Carolyn Bridges et al. (2000). Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial.

What about serious reactions to flu vaccine?

Serious allergic reactions to flu vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after vaccination. While these reactions can be life-threatening, effective treatments are available.

What about people who get a seasonal flu vaccine and still get sick with flu symptoms?

There are several reasons why someone might get flu symptoms even after they have been vaccinated against flu.

• Someone can get sick with another respiratory virus besides flu such as rhinoviruses or SARS-CoV-2 (the virus that causes COVID-19). Other respiratory viruses can cause symptoms similar to flu, and they can also spread and cause illness during flu season. Flu vaccines only protect against flu and its complications, not other illnesses.
• Someone can be exposed to flu viruses shortly before getting vaccinated or during the two-week period after vaccination that it takes the body to develop immune protection. This exposure may result in a person becoming sick with flu before protection from vaccination takes effect.
• Flu vaccines vary in how well they work, and someone can get vaccinated but still get sick with flu. There are many different flu viruses that spread and cause illness among people, so this can happen if someone is exposed to a flu virus that is very different from the viruses in the flu vaccine. The ability of a flu vaccine to protect a person depends partially on the similarity or “match” between the vaccine viruses chosen to make vaccine and those spreading and causing illness. Even when that happens though, flu vaccination can still reduce severity of illness.

Can vaccinating someone twice provide added immunity?

In adults, studies have not shown a benefit from getting more than one dose of vaccine during the same influenza season, even among elderly persons with weakened immune systems. Except for children getting vaccinated for the first time, only one dose of flu vaccine is recommended each season.

Is it true that getting a flu vaccine can make you more susceptible to other respiratory viruses?

Flu vaccines are not thought to make people more susceptible to other respiratory infections.

A 2012 study that suggested that flu vaccination might make people more susceptible to other respiratory infections. After that study was published, many experts looked into this issue further and conducted additional studies to see if the findings could be replicated. No other studies have found this effect. It’s not clear why this finding was detected in the one study, but the majority of evidence suggests that this is not a common or regular occurrence and that flu vaccination does not, in fact, make people more susceptible to other respiratory infections.

• Maria Sundaram et al. (2013). Influenza Vaccination Is Not Associated With Detection of Noninfluenza Respiratory Viruses in Seasonal Studies of Influenza Vaccine Effectiveness.

Does a flu vaccination increase your risk of getting COVID-19?

There is no evidence that getting a flu vaccination increases your risk of getting sick from a coronavirus, like the one that causes COVID-19.

You may have heard about a study published in January 2020 that reported an association between flu vaccination and risk of four commonly circulating seasonal coronaviruses, but not the one that causes COVID-19. This report was later found to be incorrect.

The results from that initial study led researchers in Canada to look at their data to see if they could find similar results in their population. The results from this study showed that flu vaccination did not increase risk for these seasonal coronaviruses. The Canadian findings highlighted the protective benefits of flu vaccination.

The Canadian researchers also identified a flaw in the methods of the first study, noting that it violated the part of study design that compares vaccination rates among patients with and without flu (test negative design). This flaw led to the incorrect association between flu vaccination and seasonal coronavirus risk. When these researchers reexamined data from the first study using correct methods, they found that flu vaccination did not increase risk for infection with other respiratory viruses, including seasonal coronaviruses.

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MISCONCEPTIONS ABOUT FLU VACCINE EFFECTIVENESS

Influenza (flu) vaccine effectiveness (VE) can vary. The protection provided by a flu vaccine varies from season to season and depends in part on the age and health status of the person getting the vaccine and the similarity or “match” between the viruses in the vaccine and those in circulation. During years when the flu vaccine match is good, it is possible to measure substantial benefits from flu vaccination in terms of preventing flu illness and complications. However, the benefits of flu vaccination will still vary, depending on characteristics of the person being vaccinated (for example, their health and age), what flu viruses are circulating that season and, potentially, which type of flu vaccine was used. More information is available at Vaccine Effectiveness – How well does the Flu Vaccine Work.

Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits.

• Flu vaccination can keep you from getting sick with flu.
  • Flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 7.5 million influenza illnesses, 3.7 million influenza-associated medical visits, 105,000 influenza-associated hospitalizations, and 6,300 influenza-associated deaths.
  • During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.
• Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.
  • A 2021 study showed that among adults hospitalized with flu, vaccinated patients had a 26% lower risk of intensive care unit (ICU) admission and a 31% lower risk of death from flu compared with those who were unvaccinated.
  • A 2018 study showed that among adults hospitalized with flu, vaccinated patients were 59% less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent four fewer days in the hospital than those who were not vaccinated.
• Flu vaccination can reduce the risk of flu-associated hospitalization.
  • Flu vaccine prevents tens of thousands of hospitalizations each year. For example, during 2019-2020 flu vaccination prevented an estimated 105,000 flu-related hospitalizations.
  • A 2018 study showed that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an ICU with flu by 82%.
  • A 2017 study found that during 2009-2016, flu vaccines reduced the risk of flu-associated hospitalization among older adults by about 40% on average.
  • A 2014 study showed that flu vaccination reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.
• Flu vaccination is an important preventive tool for people with certain chronic health conditions.
  • Flu vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who have had a cardiac event in the past year.
  • Flu vaccination can reduce the risk of a flu-related worsening of chronic lung disease (for example, chronic obstructive pulmonary disease (COPD) requiring hospitalization).
  • Among people with diabetes and chronic lung disease,flu vaccination has been shown in separate studies to be associated with reduced hospitalizations from a worsening of their chronic condition.
• Flu vaccination during pregnancy helps protect pregnant people from flu during and after pregnancy and helps protect their infants from flu in their first few months of life.
  • A 2013 study showed that during the 2010–2011 and 2011–2012 flu seasons vaccination reduced the risk of flu-associated acute respiratory infection in pregnant people by about one-half.
  • A 2018 study showed that getting a flu shot reduced a pregnant person’s risk of being hospitalized with flu by an average of 40% from 2010-2016.
  • A number of studies have shown that in addition to helping to protect pregnant people from flu, a flu vaccine given during pregnancy helps protect the baby from flu for several months after birth, when babies are too young to be vaccinated.
• Flu vaccine can be lifesaving in children.
  • A 2022 study showed that flu vaccination reduced children’s risk of severe life-threatening influenza by 75%.
  • A 2020 study found that during the 2018-2019 flu season, flu vaccination reduced flu-related hospitalization by 41% and flu-related emergency department visits by half among children (aged 6 months to 17 years old).
  • A 2017 study was the first of its kind to show that flu vaccination can significantly reduce children’s risk of dying from flu.
• Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

Despite the many benefits offered by flu vaccination, only about half of Americans get an annual flu vaccine. During an average flu season, flu can cause millions of illnesses, hundreds of thousands of hospitalizations and tens of thousands of deaths. Many more people could be protected from flu if more people got vaccinated.

*References for the studies listed above can be found at Publications on Influenza Vaccine Benefits.

MISCONCEPTIONS ABOUT THE TIMING OF SEASONAL INFLUENZA VACCINATION

Should I wait to get vaccinated so that my immunity lasts through the end of the season?

How long you are immune or your “duration of immunity” is discussed in the ACIP recommendations. While delaying getting of vaccine until later in the fall may lead to higher levels of immunity during winter months, this should be balanced against possible risks, such as missed opportunities to receive vaccine and difficulties associated with vaccinating a large number of people within a shorter time period.

Is it too late to get vaccinated after Thanksgiving (or the end of November)?

No. Vaccination can still be beneficial as long as flu viruses are circulating. If you have not been vaccinated by Thanksgiving (or the end of November), it can still be protective to get vaccinated in December or later. Flu is unpredictable and seasons can vary. Seasonal flu disease usually peaks between December and March most years, but disease can occur as late as May.

MISCONCEPTIONS ABOUT PHYSICIAN CONSENT FOR VACCINATION

Do pregnant people or people with pre-existing medical conditions need special permission or written consent from their doctor to get a flu vaccine?

No. There is no recommendation for pregnant people or people with pre-existing medical conditions to seek special permission or secure written consent from their doctor for vaccination if they get vaccinated at a worksite clinic, pharmacy or other location outside of their physician’s office. With rare exception, CDC recommends an annual flu vaccine for everyone 6 months of age and older, including pregnant people and people with medical conditions.

A variety of flu vaccines are available (Table 1). Vaccine providers should be aware of the approved age indications of the vaccine they are using and of any contraindications or precautions. Providers also should appropriately screen all people getting vaccinated for allergies to vaccine components or other contraindications. People who have previously had a severe allergic reaction to influenza vaccine or any of its ingredients should generally not be vaccinated.

There are some people who should not get a flu vaccine without first speaking with their doctor. These include:

• People who have a moderate-to-severe illness with or without a fever (they should wait until they recover to get vaccinated), and
• People with a history of Guillain-Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.

Pregnant people or people with pre-existing medical conditions who get vaccinated should get a flu shot.

If a person is vaccinated by someone other than their primary health care provider, the vaccinating provider should ensure that the patient and, if possible, the patient’s medical provider have documentation of vaccination.

For a complete list of people who should not get a flu vaccine before speaking with their doctor, please review the influenza Vaccine Information Statement for the inactivated or recombinant flu vaccine or live, intranasal influenza vaccine.

MISCONCEPTIONS ABOUT “STOMACH FLU”

Is the “stomach flu” really flu?

No. Many people use the term “stomach flu” to describe illnesses with nausea, vomiting or diarrhea. These symptoms can be caused by many different viruses, bacteria or even parasites. While vomiting, diarrhea, and being nauseous or “sick to your stomach” can sometimes be related to flu — more commonly in children than adults — these problems are rarely the main symptoms of influenza. Flu is a respiratory disease and not a stomach or intestinal disease.

To learn more, please visit https://www.cdc.gov/flu/prevent/misconceptions.htm.

1. Does vision loss affect a lot of people?

Yes. More than 3.4 million Americans aged 40 years and older are blind (having a visual acuity of 20/200 or less or a visual field on 20 degrees or less) or visually impaired (having a visual acuity of 20/40 or less). Other estimates of “vision problems” range as high as 21 million, and a total of 80 million Americans have potentially blinding eye diseases. The major causes of vision loss are cataracts, age-related macular degeneration, diabetic retinopathy, and glaucoma.

2. Does vision loss contribute a large burden in terms of morbidity, quality of life, and cost?

Yes. People with vision loss are more likely to report depression, diabetes, hearing impairment, stroke, falls, cognitive decline, and premature death. Decreased ability to see often leads to the inability to drive, read, keep accounts, and travel in unfamiliar places, thus substantially compromising quality of life. The cost of vision loss, including direct costs and lost productivity, is estimated to exceed $35 billion (Rein, Zhang, Wirth, et al., 2006)

3. Has vision loss recently increased and will it increase in the future?

Yes. As the population of older people continues to accelerate, the number of people experiencing vision loss will continue to increase. And as the population of people experiencing diabetes increases, consequent increases will occur in diabetic retinopathy and other eye diseases. Prevent Blindness America estimates that the population of people experiencing blindness and visual impairment will double by 2030 unless corrective actions are taken.

4. Is vision loss perceived to be a threat by the public?

Yes. Vision loss ranks among the top ten causes of disability in the United States, and it is a condition feared by many.

5. Is it feasible to act on vision loss at a community or public health level?

Yes. Scientific evidence shows that early detection and treatment can prevent much blindness and vision impairment. Efficacious and cost-effective strategies to detect and treat diabetic retinopathy are available, but among people with diabetes, screening is received only by about two-thirds of persons for whom the exam is recommended and varies significantly across health care settings. Cataract removal surgery can restore vision, and this surgery is cost effective; however, among African Americans, unoperated senile cataracts remain a major cause of blindness. Glaucoma can be controlled, and vision loss stopped by early detection and treatment. Nevertheless, half the people with glaucoma are not diagnosed, and glaucoma is still the number one blinding disease among African Americans.

Public health serves to address each of these questions by conducting population-based investigations to determine the population, characteristics, circumstances, and trends of vision loss, as well as developing and implementing evidence based, cost-effective interventions to assure access to vision care and health behaviors to prevent the onset of vision loss and to improve the health and quality of life for those who have lost vision.

To learn more, please visit https://www.cdc.gov/visionhealth/basic_information/vision_loss.htm.

Patients and residents of nursing homes, assisted living facilities, and other long-term care facilities should be aware of the risks of developing infections due to comorbidities and associated disease processes.

CRE Infection (Carbapenem-resistant Enterobacterales)

CRE are germs that are difficult to treat because they are resistant to the drugs (antibiotics) used to treat them.

You are most at risk for a CRE infection if you require a device like a:

• ventilators (breathing machines)
• urinary (bladder) catheters
• intravenous (vein) catheters

C. diff Infection (Clostridioides difficile)

C. diff is a germ that causes an inflammation of the colon, called colitis. Diarrhea and fever are the most common symptoms. Overuse of antibiotics is the most important risk for getting a C. diff infection.

CAUTI (Catheter-Associated Urinary Tract Infection)

An indwelling urinary catheter is a drainage tube that is inserted into the urinary bladder, which is left in place and connected to a collection bag. A CAUTI occurs when germs (usually bacteria) enter the urinary tract through the urinary catheter and cause infection.

Flu (Influenza)

You can get the flu anywhere, including healthcare settings such as nursing homes and long-term care facilities. Therefore, influenza prevention measures should be implemented in all healthcare settings.

MRSA Infection (Methicillin-resistant Staphylococcus aureus)

MRSA is a type of bacteria that is resistant to many antibiotics used to treat them. Severe MRSA infections occur most frequently among patients in healthcare settings such as nursing homes and long term care facilities.

Stomach Flu (Norovirus)

Stomach flu is caused by the Noroviruses. Symptoms include severe vomiting and diarrhea. Stomach flu is usually brief in people who are otherwise healthy. Young children, the elderly, and people with other medical illnesses are most at risk for more serious infection. Like all viral infections, noroviruses should not be treated with antibiotics.

To learn more, please visit https://www.cdc.gov/longtermcare/resident/index.html.

In 2020, there were almost 48 million licensed drivers ages 65 and older in the United States. This is a 68% increase since 2000.¹

Driving helps older adults stay mobile and independent. But the risk of being injured or killed in a traffic crash increases as people age.

Thankfully, older adults can take steps to stay safer on the roads.

Thousands of older adults are injured or killed in the United States every year in traffic crashes.

In 2020, about 7,500 older adults were killed in traffic crashes, and almost 200,000 were treated in emergency departments for crash injuries.² This means that each day, 20 older adults are killed and almost 540 are injured in crashes.

Age, gender, and age-related changes are major risk factors.

• Drivers aged 70+ have higher crash death rates per 1,000 crashes than middle-aged drivers (aged 35-54).³ Higher crash death rates among this age group are primarily due to increased vulnerability to injury in a crash.
• Across all age groups, males have substantially higher crash death rates than females.⁴
• Age-related changes in vision, physical functioning, and the ability to reason and remember, as well as some diseases and medications, might affect some older adults’ driving abilities.⁵

Key steps to staying safe on the roads.

The good news is that older adults are more likely to have safer driving behaviors than other age groups.

Taking these key steps can help adults of all ages, including older adults, stay safe on the road:

• Always wear a seat belt as a driver or passenger
  Seat belt use is one of the most effective ways to save lives and reduce injuries in crashes.⁶
• Drive when conditions are safest
  Drive during daylight and in good weather. Conditions such as poor weather⁷ and driving at night⁸ increase the likelihood of crash injuries and deaths.
• Don’t drink and drive
  Drinking and driving increases the risk of being in a crash because alcohol reduces coordination and impairs judgment.

Additional steps to stay safe on the road

• Use CDC’s MyMobility Plan, a plan to stay mobile and independent as you age.
• Follow a regular activity program to increase strength and flexibility.
• Ask your doctor or pharmacist to review medicines—both prescription and over-the counter—to reduce side effects and interactions. Read the Are Your Medicines Increasing Your Risk of a Fall or a Car Crash fact sheet to learn more.
• Have your eyes checked by an eye doctor at least once a year. Wear glasses and corrective lenses as required.
• Plan your route before you drive.
• Find the safest route with well-lit streets, intersections with left-turn signals, and easy parking.
• Leave a large following distance between your car and the car in front of you.
• Avoid distractions in your car, such as listening to a loud radio, talking or texting on your phone, and eating.
• Consider potential alternatives to driving, such as riding with a friend, using ride share services, or taking public transit.

To learn more, please visit https://www.cdc.gov/transportationsafety/older_adult_drivers/index.html.

RSV infections can be dangerous for certain adults. Each year, it is estimated that between 60,000-160,000 older adults in the United States are hospitalized and 6,000-10,000 die due to RSV infection. Adults at highest risk for severe RSV infection include:

• Older adults
• Adults with chronic heart or lung disease
• Adults with weakened immune systems
• Adults with certain other underlying medical conditions
• Adults living in nursing homes or long-term care facilities

An RSV vaccine protects against serious disease

RSV vaccines can help protect adults aged 60 years and older from RSV. Talk to your healthcare provider to see if vaccination is right for you.

You can get an RSV vaccine at the same time you get other recommended vaccines, such as flu or COVID-19 vaccines. For information about where to find vaccines in your area, visit Vaccine Information for Adults | Where to Find Adult Vaccines | CDC.

Severe RSV Infection

When an adult gets RSV infection, they typically have mild cold-like symptoms, but some may develop a lung infection or pneumonia.

RSV can sometimes also lead to worsening of serious conditions such as:

• Asthma
• Chronic obstructive pulmonary disease (COPD) – a chronic disease of the lungs that makes it hard to breathe
• Congestive heart failure – when the heart can’t pump enough blood and oxygen through the body

Older adults who get very sick from RSV may need to be hospitalized. Some may even die. Older adults are at greater risk than young adults for serious complications from RSV because our immune systems weaken when we are older.

What you should do if you or a loved one is at high risk for severe RSV disease

RSV season in most regions of the U.S. starts in the fall and peaks in winter. If you are at high risk for severe RSV infection, or if you interact with an older adult, you should take extra care to keep them healthy:

• Wash your hands often
  Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. Washing your hands will help protect you from germs.
• Avoid touching your face with unwashed hands
  Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.
• Avoid close contact with sick people
  Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.
• Cover your coughs and sneezes
  Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward.
• Clean frequently touched surfaces
  Clean surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.
• Stay home when you are sick
  If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness.

To learn more, please visit https://www.cdc.gov/rsv/high-risk/older-adults.html.

Boyd Nursing and Rehabilitation is excited to share resident Susan Castle’s Success Story!

Susan came to Boyd Nursing & Rehab in August of this year for rehabilitation after sustaining a right hip fracture following a fall. The traumatic injury left her immobile and dependent on caregiver assistance to complete basic self-care tasks. Susan and her family knew the journey to recovery would be challenging, and returning home anytime soon was not possible given the extent of her deficits. Therefore, they opted for rehabilitation at Boyd Nursing. Boyd takes a comprehensive and collaborative approach to rehabilitation.

Over the next several weeks, Susan received physical and occupational therapy services in addition to nursing, dietary, and social service interventions to facilitate a successful recovery. Susan has regained her independence to perform self-care tasks and mobility using an adaptive device. Susan is returning home with the additional support of her loving and caring children! Thank you, Susan, for the opportunity to assist you throughout your rehabilitation experience!

Older adults are more sensitive to cold (and heat) than younger adults. Body temperature below 95°F, or hypothermia, increases their risk of heart disease and kidney or liver damage, especially if they have a history of low body temperature or have had hypothermia in the past.

What is Hypothermia?

Hypothermia is often caused by being in very cold temperatures. When you are cold, you begin to lose heat faster than your body can produce it. Eventually, you will use up your stored energy, causing your body temperature to go down.

• Hypothermia affects the brain, making it hard to move or think clearly. That’s why it’s dangerous—because you may be unaware of what’s happening and how to stop it.
• While hypothermia is most common at very cold temperatures, it can occur even at cool temperatures (above 40°F) if you become chilled from rain, sweat, or being in cold water.
• If you have a chronic condition such as diabetes, Parkinson’s, memory loss, or thyroid problems, you may take medicines that make it hard to regulate your body temperature. Ask your doctor if this is an issue for you or any questions you might have about hypothermia.

How to Tell if Someone Has Hypothermia and What to do

• Early signs include cold feet or hands, swollen face, slower-than-normal speech, and feeling sleepy, angry, or confused. The person’s skin may become pale, and they may begin shivering.
• Later signs include jerking movements that the person can’t control in their arms and legs, slow heartbeat, slow, shallow breathing, and going in and out of consciousness.
• If you see someone showing signs of hypothermia, call 911. While waiting for 911:
  • Move the person to a warmer place.
  • Wrap them in warm, dry clothes,
  • If necessary, remove all clothing and make skin-to-skin contact with the person to transfer body heat. Wrap yourself and the person in dry blankets to stay warm.
  • Give them something warm to drink (no alcohol or caffeine).

Learn more about hypothermia and frostbite prevention and steps to take when you recognize someone else has hypothermia.

How to Help Someone with Dementia Avoid Hypothermia

About 1 in 4 people who have dementia live alone. People with dementia may not be aware of their surroundings. Learn how to make a home safe for someone with dementia, and use these tips to help someone with dementia stay safe during very cold weather.

• Remove portable space heaters and don’t leave the person alone with an open fireplace. Use safety knobs and use a stove with automatic shutoff settings.
• Advise the person to carefully use electric blankets and sheets or heating pads; explain they can cause burns.
• Put red tape around vents, radiators, and other heating components to remind the person to avoid touching them.
• Keep the water heater set to 120°F to prevent burns. Consider installing faucets that mix hot and cold water.
• Leave an extra house key outside the home in case a caregiver or emergency responder needs to get inside.

How to Avoid Hypothermia at Home When It’s Very Cold Outside

You can get hypothermia while indoors if outside cold weather persists or when you are working in cold environments, such as a storage freezer.  Use the steps below to prevent hypothermia while indoors.

• Eat a healthy diet every day to make sure your body has enough energy to keep you warm.
• Make sure to stay hydrated
• Limit your alcohol intake.

• Wear warm, thick clothing, including a hat and scarf if needed. Try to keep a blanket nearby.
• If you live alone, ask friends and family to check on you.
• Check your thermostat or an easy-to-read indoor thermometer often. If you don’t have an easy-to-read thermometer, try to have one installed if possible.
  • Keep the house around 68°F to 70°F.
    • Maintain your heating and air conditioning system.
    • Block off any unused rooms and drafts from windows and doors.
    • If you use a fireplace or wood stove as your main heating source, have your chimney or flue inspected every year.
    • If your home doesn’t hold heat well, have the insulation checked.

Financial help is sometimes available for people who can’t afford to weatherize their home or pay their heating bills.

For financial help getting your windows, doors, and furnace checked to make sure they are cold-weather-ready, or for other weather-related changes to your home, contact your local Weatherization Assistance Program.

For help with your energy bills, contact:

• National Energy Assistance Referral (1-866-674-6327 (toll-free; TTY, 1-866-367-6228)
• Low Income Home Energy Assistance Program. You can email them at energyassistance@ncat.org

If you are using a portable heater, here are 7 Safety Tips from Consumer Product Safety Commission.

How to Avoid Hypothermia if you Go Outside During Cold Winter

• Wear warm, thick clothing, including a hat, scarf, and gloves, as well as loose layers to increase the amount of body heat.
• Change your clothes as soon as you get inside. Wearing wet clothes causes your body temperature to drop. Dry clothes allow your body to

warm itself.

• If you drive somewhere, be prepared in case you get stranded.
  • Keep warm blankets and clothing in your car.
  • Keep food and water in your car.
  • Keep a phone charger in your car.
  • Take any necessary medicines with you.

Create a winter emergency supply kit to keep in your car

How to Avoid Falling if You Go Outside in Icy Weather

During the winter months, it’s important to make sure that surfaces are dry and safe for walking to reduce the risk of falling. These tips can you help prevent falls in icy and snowy weather:

• Make sure there is enough lighting outdoors, especially near walkways and stairs. Low lighting is a major cause of falls. Motion-sensor lights might be useful.
• Keep outside walkways and steps clear of snow, ice, and any objects
• If your home’s main entrance is often icy during the winter months, use a different entrance if you can.
• Make sure your steps are sturdy and have textured grip to reduce falls if the weather is icy or wet.
• If you use walking aids such as a cane, walker, or a wheelchair, dry the wheels or tips of each before entering your home.
• Keep a small table or shelf near the entry door to put items while unlocking the door. This reduces distractions and dangers of slipping or tripping while trying to enter your home.

How You Can Help an Older Adult Avoid Hypothermia

As a friend, family member, or caregiver to an older adult during the winter months, you can:

• Consider having a remote indoor air temperature sensor or monitor installed.
• Have the name and contact information of a nearby family member or friend who can regularly check in on them.
• Create a care plan with them to provide structure for both of you. The care plan should include ways to maintain a healthy body temperature and note if any medicines they take affect their ability to regulate body temperature.
• If you are checking in on an older adult, try to check in on them in person or by telephone as often as possible or at agreed times to make sure they:
  • Are staying hydrated.
  • Have the living space set to a comfortable temperature.
  • Are keeping warm.
  • Don’t show signs of hypothermia.

To learn more, please visit https://www.cdc.gov/aging/emergency-preparedness/older-adults-extreme-cold/index.html.

Loneliness and social isolation in older adults are serious public health risks affecting a significant number of people in the United States and putting them at risk for dementia and other serious medical conditions.

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated.¹ Older adults are at increased risk for loneliness and social isolation because they are more likely to face factors such as living alone, the loss of family or friends, chronic illness, and hearing loss.

Loneliness is the feeling of being alone, regardless of the amount of social contact. Social isolation is a lack of social connections. Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated.

Health Risks of Loneliness

Although it’s hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk. Recent studies found that:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.¹
• Social isolation was associated with about a 50% increased risk of dementia.¹
• Poor social relationships (characterized by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.¹
• Loneliness was associated with higher rates of depression, anxiety, and suicide.
• Loneliness among heart failure patients was associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.¹

Immigrant, LGBT People Are at Higher Risk

The report highlights loneliness among vulnerable older adults, including immigrants; lesbian, gay, bisexual, and transgender (LGBT) populations; minorities; and victims of elder abuse. It also points out that the literature base for these populations is sparse and more research is needed to determine risks, impacts, and appropriate actions needed.

Current research suggests that immigrant, and lesbian, gay, bisexual populations experience loneliness more often than other groups. Latino immigrants, for example, “have fewer social ties and lower levels of social integration than US-born Latinos.” First-generation immigrants experience stressors that can increase their social isolation, such as language barriers, differences in community, family dynamics, and new relationships that lack depth or history, the report states. Similarly, gay, lesbian, and bisexual populations tend to have more loneliness than their heterosexual peers because of stigma, discrimination, and barriers to care.

What Can You Do If You Are Experiencing Loneliness?

Your doctor can assess your risk for loneliness and social isolation and get you connected to community resources for help, if needed. The following national organizations also offer helpful resources:

AARP—Provides helpful information to seniors to help improve quality of life and provides access to Community Connection Tools.

Area Agencies on Aging (AAA)—A network of over 620 organizations across America that provides information and assistance with programs including nutrition and meal programs (counseling and home-delivered or group meals), caregiver support, and more. The website can help you find your local AAA, which may provide classes in Tai Chi and diabetes self-management.

Eldercare Locator—A free national service that helps find local resources for seniors such as financial support, caregiving services, and transportation. It includes a brochure that shows how volunteering can help keep you socially connected.

National Council on Aging—Works with nonprofit organizations, governments, and businesses to provide community programs and services. This is the place to find what senior programs are available to assist with healthy aging and financial security, including the Aging Mastery Program® that is shown to increase social connectedness and healthy eating habits.

National Institute on Aging (NIA)– Provides materials on social isolation and loneliness for older adults, caregivers, and health care providers. Materials include health information, a print publication available to view or order no-cost paper copies, a health care provider flyer, and social media graphics and posts.

Health Care System Interventions Are Key

People generally are social by nature, and high-quality social relationships can help them live longer, healthier lives. Health care systems are an important, yet underused, partner in identifying loneliness and preventing medical conditions associated with loneliness.

Nearly all adults aged 50 or older interact with the health care system in some way. For those without social connections, a doctor’s appointment or visit from a home health nurse may be one of the few face-to-face encounters they have. This represents a unique opportunity for clinicians to identify people at risk for loneliness or social isolation.

NASEM recommends that clinicians periodically assess patients who may be at risk and connect them to community resources for help. In clinical settings, NASEM recommends using the Berkman-Syme Social Network Index (for measuring social isolation) and the three-item UCLA Loneliness Scale (for measuring loneliness).

But patients must make their own decisions. Some people may like being alone. It is also important to note that social isolation and loneliness are two distinct aspects of social relationships, and they are not significantly linked. Both can put health at risk, however.

To learn more, please visit https://www.cdc.gov/aging/publications/features/lonely-older-adults.html.

An Emerging Public Health Issue

Millions of older adults and people with disabilities could not maintain their independence without the help of unpaid caregivers. This care would cost nearly $470 billion a year if purchased. That’s one of the reasons that caregiving is an essential public health service and should be prioritized as an emerging public health issue [PDF – 1 MB].¹

Caregivers are family members or friends who typically provide unpaid, long-term, community-based care and assistance to older adults and people with chronic health conditions or disabilities.  Caregivers help with a variety of routine tasks such as shopping, paying bills, bathing, dressing, and managing medicines.  They are often a source of emotional support and companionship for care recipients.

Caregivers: A Snapshot

• 58% of caregivers are women.
• Almost one-third of caregivers provide care at least 20 hours a week.
• Caregivers typically learn as they go and aren’t formally trained.
• 79% of caregivers care for adults aged 50 or older, and 76% of care recipients are aged 65 years and older.² 
• One in 6 non-caregivers expects to become a caregiver within two years.

Increasing Demand for Caregivers

The need for caregivers is growing along with the aging of the US population. The number of caregivers increased from 43.5 million in 2015 to about 53 million in 2020, or more than 1 in 5 Americans.³ By 2030, an estimated 73 million people in the United States will be 65 years or older.⁴ Many will require daily assistance from at least one caregiver to maintain quality of life, independence, and physical and social well-being. More than two-thirds of the US population will likely need help with tasks at some point in their lifetime.⁵

Benefits of Caregiving for Recipients and Caregivers

Caregiving allows recipients to:

• Retain their quality of life and independence.
• Avoid living in a group setting (institutionalization).
• Have less depression.
• Self-manage their chronic conditions better.

Caregiving can also benefit caregivers by helping them:

• Increase their self-confidence and fulfillment from helping others.
• Start or add to social networks of friendships associated with caregiving.
• Feel needed and useful.
• Learn and develop new skills.

Caregiving Burdens and Stress

Caregiving is also a public health concern because it can lead to physical, emotional, psychological, and financial strain.  Providing personal care and helping with behavioral and cognitive issues can be stressful for caregivers and result in depression and anxiety. Nearly 1 in 5 caregivers reports fair or poor health.⁶ Caregivers often neglect their own health needs, increasing their risk of having multiple chronic conditions. Nearly 2 in 5 caregivers have at least two chronic diseases:

• 1 in 7 caregivers has heart disease and/or stroke.
• 1 in 5 caregivers aged 65 and older have coronary heart disease and/or stroke.

A recent study by the National Alliance for Caregiving and AARP found nearly 1 in 4 US caregivers says caregiving has made their health worse.³

Financial Strains of Caregiving

Caregiving can have a negative financial effect on caregivers. Many employed caregivers have had to leave work early or take time away from work, resulting in lost wages. Nearly 2 in 10 employed caregivers had to stop working, while 4 in 10 had to reduce their working hours to care for a loved one.⁷ Caregivers sometimes pay out-of-pocket for caregiving services, meals, medical supplies, and other expenses. Almost 80% of caregivers report paying out-of-pocket for routine expenses for care recipients. The average annual out-of-pocket cost for caregivers is $7,200, and this cost rises to nearly $9,000 per year for caregivers of someone with dementia. ⁸

How to Support Caregivers?

• Help them with errands, chores, and other tasks.
• Provide emotional and social support.
• Negotiate times to check in on them.
• Make sure they are managing their own health care needs.
• Help them create and manage a care plan for the person they care for.
• Encourage them to seek mental health services if necessary.

If you are a caregiver, read about respite care.

To learn more, please visit https://www.cdc.gov/aging/publications/features/supporting-caregivers.htm.

Keeping Engaged Socially is good for your health!

We are not talking about your marital status. We mean, do you participate in activities that connect you with other people? As people get older, their social lives oftentimes slow down for a variety of reasons. When it is unwanted, this can lead to loneliness and isolation. Research has shown that for older adults, staying engaged in enjoyable activities is associated with better physical and mental health. As we age, being involved with others is strongly associated with better brain function. So it is not only fun, it is good for you! You might not have ever imagined that while you were singing in the church choir, or meeting with your book club, or volunteering at the animal shelter that you were actually improving your brain health!

In addition, research has shown that learning a new activity for older people can provide some “insurance” against memory loss. However, it cannot prevent progressive diseases like Alzheimer’s and other dementias.

There are many ways to get involved in your local community. Some to consider include:

• Participate in sports—whether tai chi or tennis, there’s something for every interest and ability.
• Head outdoors—join a walking, hiking, or bird watching group.
• Make music—join a choir or band or take lessons.
• Get involved—participate with a church, temple, or other religious organization.
• Read, join, participate, or start a book club.
• Volunteer for a cause or group you’re passionate about.
• Take classes at a gym.
• Find (or start!) a group that fits your passion —whether it’s knitting or carpentry.
• Indulge your creativity —stage a play with friends, create a themed-dining dinner club, or take an art class.

There are national organizations that can help connect you with these kinds of activities, including:

• Websites like VolunteerMatch, Idealist, and AARP’s Create the Good help connect people and nonprofits who care about similar causes.
• AARP’s Experience Corp  is an AmeriCorps program that trains adults 50+ to tutor elementary students who aren’t reading at grade level.
• The American Volkssport Association is a national organization promoting physical fitness, with has many local clubs that sponsor walks and other fitness events.
• Meetup is a website that helps connect people with common interests of all kinds, so they can meet up and enjoy discussions and activities.
• SilverSneakers is a national network of gyms with free membership for those with participating health plans, and a community of other adults seeking to remain fit and involved.
• The Senior Theater Resource  provides information for older adults interested in performing.
• Encore.org is an online resource for those interested in utilizing their experience and knowledge to do work—paid or unpaid—with social impact, to benefit future generations.

So why not take some steps to stay connected and keep your brain healthy – through an activity you enjoy – with your community?

SHARP Program

An example of a memory prompt for walkers in the SHARP Program.

Portland, Oregon is one community where theories about the benefits of increasing social engagement and brain health are being put into action. The Sharing History through Active Reminiscence and Photo-imagery (SHARP) Program, run by the Oregon Health & Science University (OHSU), brings together small groups of older African Americans for mile-long GPS-guided walks. Historic photos of local interest, like the one above, appear on the group’s digital device at selected locations. At each of these Memory Markers, the group pauses to discuss the photograph and flex their memories. The SHARP program specifically targets African Americans, who may be less aware than white Americans of the risk of Alzheimer’s Disease, have higher rates of some possible dementia risk factors, and be slower to seek care.

OHSU runs the SHARP program as part of the Healthy Brain Research Network, a thematic network of CDC Prevention Research Centers that promotes cognitive health and supports older Americans with cognitive decline as well as their caregivers. Through a unique combination of social engagement, exercise, and memory stimulation, the SHARP program aims to promote healthy aging of mind and body, preserve neighborhood memories, and increase awareness of Alzheimer’s Disease in a local community.

To learn more, please visit https://www.cdc.gov/aging/publications/features/social-engagement-aging.html.