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The focus of the article is upon the unique constitution and needs of the elderly, not upon herpes zoster or influenza as a national phenomenon particular to the United States. However, all of the studies it cites are based in the United States, and RSV has been primarily studied as a phenomenon occurring in the U.S. The prevalence of nursing homes in the United States might also make the article more relevant to U.S. practitioners, and the regulatory and drug treatments it discusses are particular to North American, such as the FDA.
Supporting evidence: What scientific evidence does the author(s) present to support his or her claims?
The article's most conclusive evidence is found in its treatment of influenza. It notes that in the 40% to 60% of elderly patients in whom the influenza vaccine produces the desired immunity, an effective immune response can be mounted within 10 to 14 days after vaccination. Also, reflecting its national orientation, it notes that studies in the U.S. show that influenza vaccination consistently decreased frequencies of congestive heart failure, hospitalization for respiratory disease and death from any cause in elderly adults. Additionally, vaccination of the elderly in long-term care facilities is associated with decreased risk of pneumonia and death.
Its discussion of shingles is less conclusive in its prescriptions, other than the assertion that patients should avail themselves of the FDA approved drugs that are least apt to produce side effects. Its discussion of RSV is also quite brief. This may be due to the fact that RSV a relatively recently discovered cause of lower respiratory tract infection in elderly patients, which is treated with primarily supportive treatment such as rest and fluids....
Because the ailments have varying causes, etiologies, and are treated in very different ways (drugs, vaccination, and rest, respectively) the article is informative, but does not entirely cohere as an analytical piece. It is compelling in its advocacy of the need to treat influenza with a vaccine, to prevent the cause of this incapacitating ailment, and it is also persuasive in the way that it demonstrates how viral illnesses of any kind can restrict the lives of the elderly in both nursing homes and in the community.
One additional area it could have addressed is the availability of the chicken pox vaccine. Although this is usually given to young children, it might be interesting to note that if all of today's children are vaccinated against chicken pox, in the succeeding generations of elderly patients, at least this viral ailment could conceivably become part of our epidemiological past. Conversely, the new illness RSV is given very little attention, perhaps reflecting a lack of clinical data. Why this new illness has occurred, and if there is any current research into new drugs to treat the illness might have been interesting to address in brief.
References
Bader, Mazen & David S. McKinsey. (2005, Nov). "Viral infections in the elderly."
Postgraduate Medicine. 118.5: 45-54
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