A 5-year experience with influenza prevention and containment in a program of all-inclusive care for elderly adults

Influenza causes mortality and morbidity in the frail elderly population. Influenza prevention and mitigation models need to be developed for this population.

An observational study at a Program for All-Inclusive Care for the Elderly (PACE) during years 1999-2004. Participants were frail elderly adults who meet the state Medicaid requirements for nursing home placement.

Over 91% of participants have been immunized yearly since the beginning of the program. Employee immunization has increased yearly from 61% to 90%, and caregivers known to be immunized increased from 9% to 62% over the last 4-year period. During 2 influenza seasons, we placed all our participants on ramantidine prophylaxis within a 2-week period.

The incentives and flexibility offered by PACE have allowed our participants to enjoy much higher influenza immunization rates than experienced by other elderly adults while also prophylaxing employees and caregivers. Our systems have allowed us to prophylax all our participants within a short time during 2 influenza seasons. Nonetheless, many questions remain regarding the optimal way to decrease the burden of influenza in frail elderly adults. With adequate integration and supplementary financing, PACE programs throughout the United States could serve as laboratories to test candidate interventions.