¶ … Reducing Hospitalization in the Elderly Population Practice Issue or Problem in Advanced Practice Nursing

Immunization has been regarded as the keystone of influenza-linked mortality and morbidity prevention (Dominguez et al. 2016). Inactivated Influenza Vaccine's efficacy in elderly individuals has been studied; a majority of scholars strongly recommend immunization in individuals aged 65+ (Dawood et al. 2014). Existing vaccines are given for the purpose of inducing serum anti-hemagglutinin antibodies to avoid ailment and infection resulting from an attack of natural influenza. Administration of annual influenza shots to vulnerable persons continues to be practiced on a widespread scale, with aged persons (i.e., 65+ years of age) being the key target population. Trivalent inactivated vaccines for influenza are deemed to be efficient as well as economical. But despite extensive influenza inoculation drives, aged inpatients are increasingly seen in hospitals, for severe cardiovascular and respiratory issues, in the course of recent yearly national outbreaks of influenza (Lang et al. 2012).

Background Information/Clinical Significance

Despite extensively available influenza inoculation initiatives, poor vaccination coverage rates continue to be experienced; the nation's health sector fails to perform up to WHO targets for its vaccine coverage. This, indeed, partly accounts for influenza infection persisting as a key global public health issue. A National Institutes of Health study's authors arrived at the conclusion that seasonal spells of influenza annually accounted for 41,000 deaths, and over 200,000 hospitalizations; further, influenza constituted the 7th key cause of mortality. Influenza-related mortality and morbidity depicts highest concentration among individuals aged 65+ as this group is more vulnerable to developing complications. Estimates for 2012-13 reveal that influenza immunization showed moderate effectiveness in decreasing hospitalizations because of respiratory complications and ailments (Fry et al. 2014). Researchers have also revealed that aged persons, particularly persons diagnosed with immunological disorders or chronic ailments, accounted for nine out of ten deaths linked to influenza. But significant uncertainties exist with regard to influenza-linked hospitalization burden in aged persons (Goldstein et al. 2015).

The common belief is that existing influenza vaccines prove effective in the prevention of elderly individuals' (aged 65+) hospitalizations. But although trivalent inactivated vaccines for influenza avert lab-tested and -confirmed influenza among roughly 70 to 90% of fit adults in cases where the circulating virus and vaccine are antigenically identical, only a vague picture is presented in case of elderly persons. This greatly restricts randomized clinical trials' (RCTs') effectiveness in informing clinicians of the advantages of inoculation when it comes to avoiding hospitalization. A Netherlands-based placebo-controlled RCT performed in the course of the 1991-92 flu spell is considered the biggest and best planned study in this regard A total of 1838 fit volunteers who were aged sixty years or more received either the trivalent inactivated vaccine for influenza or a placebo, at random....

Following age-wise stratification, the research team estimated 57% influenza vaccination success in participants aged between 60 and 69 years; however, the vaccine was successful only in 23% of participants in the 70+ years, age-group. The above finding indicates that vaccine impacts reduce further with age, and this, in part, reflects age-related immune system changes (Lang et al. 2012).
Thus, existing influenza vaccine success estimations are chiefly gleaned from observational research, often employing research database or healthcare service utilization information. Drawing on the meta-analyses that summarize such estimations, this study will attempt at examining the efficiency of extant influenza vaccine plans in alleviating future hospitalization risks among aged individuals (65+ years of age) compared to non-inoculated individuals. Moreover, the study will take into account present and future influenza vaccine success optimization strategies in this high-risk group.

Search Strategy

The study, in an attempt at the identification of every meta-analysis assessing influenza vaccine success among aging/elderly people, involved an electronic literature search of databases through Ovid Technologies (PUBMED, EMBASE, MEDLINE) using the keyword combinations listed below: "influenza vaccine" [Meshed] OR "vaccine" and "influenza" [All Fields]. The right publications out of this search were chosen based on research work title, body and abstract. The outline was limited to trivalent inactivated vaccines for influenza. The study only took into consideration RCTs having clinical endpoints (no intervention/placebo against efficacy) (Lang et al. 2012).

Integration and Synthesis of Evidence

Presentation of Evidence

A Spain-based research by Dominguez and coworkers which evaluated 1038 non-immunized and immunized individuals found low inoculation rates in the country; the recommendation was to increase immunization for preventing aged individuals' hospitalization (2016). Matias and coworkers' research scrutinized information gleaned from British national databases, concentrating particularly on influenza-linked hospitalizations and mortality from 1997 to 2009 (2016). Study authors recorded highest hospitalization and mortality rates in the >75 years age group (131 deaths and 252 hospitalizations per 100,000 individuals). Additional scrutiny of the vaccine's efficacy among elderly persons (aged 65+) reviewed 64 research works in total (randomized, cohort, case-control and quasi-randomized researches evaluating success against lab-confirmed cases of influenza or similar ailments). Influenza vaccine efficacy in fighting similar diseases was found to be 23%, while it was deemed as non-significant when it came to lab-confirmed influenza (Lang et al. 2012).

In highly vulnerable aged individuals, owing to comorbid ailments, vaccination proved to be 49% successful in preventing hospital admission and 29% successful in mortality prevention. Therefore, when efficacy of influenza vaccine in adult subjects is stratified based on health status as well as age, another picture surfaces with respect to aged persons. In fact, in a majority of observational researches, underlying illness adjustments led to further growths in influenza vaccine success estimates (Lang et al. 2012).

Critique of Evidence

Although administrative datasets have been considered effective means of gauging the efficacy of influenza vaccine, this will likely be susceptible to problematic bias, and hence, estimate validity derived thus seems to be doubtful. Likewise, observational immunogenicity…