A geriatrician's insight into reducing the burden of disease in older adults

Clare Taylor: 0:16

Welcome all to ESWI Airborne. This is your host, Clare Taylor speaking, and this is where we meet the members of ESWI, the European Scientific Working Group on Influenza. This is the place to be to get the latest news and insights on viruses, vaccines and more. We go direct to ESWE's expert members of the scientific and medical communities working on these important topics. Today we'll be talking all about respiratory syncytial virus, or RSV, and the burden of disease that this can cause in older adults. Our expert on this topic, also an ESWI board member, is Dr Stefania Maggi, research Director at CNR (Consiglio Nazionale delle Ricerche), the Italian National Research Council, the Ageing Branch, Neuroscience Institute in Padua, Italy. Stefania, you are most welcome to the ESWI Airborne studio today.

Stefania Maggi: 1:12

Thank you, happy to be here.

Great. So, Stefania, I'm very curious. We welcomed several epidemiologists to ESWI Airborne, but I think you are the first epidemiologist who is also a geriatrician, so you're focused on the health and care of older people. Why did you choose to specialise in this area?

Well, I must confess that at the beginning of my career, I was working on an internal medicine department in the University of Padua and I could have applied to become a resident in diabetology or geriatric medicine. But it was only when I went to the Johns Hopkins University in Baltimore for my Master in Public Health in the Department of Epidemiology that that I realized how interesting it was to study aging not only from the perspective of treating patients with comorbidity and frailty, but also from the perspective of promoting healthy aging and longevity. Then I decided to become a resident in geriatric medicine and to focus my research on how to promote healthy aging.

Well, that's great. And in a nutshell, what are the most important factors in your expert opinion for healthy aging?

Well, you know, I like to refer to the WHO definition of healthy aging. That is the main focus of my research and the WHO definition says that healthy aging is the process of developing and maintaining the functional ability that enables well-being in older age. And I think that this functional ability, of course, includes physical, mental and social behavioral aspects, and it has embedded the concept of life course approach, which is definitely very important And it includes different factors, such as appropriate nutrition, appropriate sleeping patterns, physical activities, social interactions, regular screening and vaccines. And I think that there is a strong evidence now from many studies that all these factors interact and they are strongly determinants of healthy aging. That's why geriatric medicine now concentrates on providing ideas for so-called wellness packages to include interventions on all these factors.

Stefania, do you feel that there's sufficient public awareness of what's necessary for older people's health, or is the culture too youth-obsessed for this to be a really a topic on the public agenda?

Well, this is a good question. I believe that there are two aspects that need to be addressed, and in both, of course, an increase of awareness would definitely help. The first aspect is related to the healthcare systems in most of our countries, and I think that when individuals have multiple, interacting medical and social problems, as it often happens for older people, they are not longer suited for health systems that are designed for individuals with single diagnosis who can be quickly discharged, for example, from hospital to their family's home. And in such health systems, older people are not usually served well and therefore they often receive inadequate care. We need really to use our scientific experience and the evidence collected to apply this knowledge to the daily clinical practice and use our knowledge to support the demand for adequate services home care services, long-term care services. On the other side, I think it is important also to underline the fact that older people are a very heterogeneous group and with some very healthy and active people who often are ignored, and they could contribute enormously to our society, such as we have seen recently during the pandemic, when retired physicians, retired nurses and social workers have volunteered and they were really instrumental in this critical point. So older people should not be considered only a burden. They are heterogeneous, they can contribute very much to the society and we have always to take into account these aspects.

So, if I understand correctly, you feel that we really need to update our approach on healthcare for older people, as well as a kind of attitude shift in considering these people as an asset and contributors to society.

Absolutely, absolutely Clare.

And in your involvement in professional associations, because I see you're working at really a high level in the European Geriatric Medicine Society, the European Interdisciplinary Council on Aging. How did these organisations engage society in the conversation?

Well, we try really to reach the general population and translate our research findings in brochure. We devote a lot of time and experience to the popularisations of the research results, also through digital technology, social media and, in particular, we care very much about the collaboration of citizens associations, who have the instruments and the know-how to reach the broader audience such as the International Federation on Ageing, the Active Citizens Group, the AARP, and the final goal of our activities is to improve the health literacy in the population, such as nutrition literacy, vaccines literacy and health in general.

In the interest of sort of increasing the literacy, the health literacy, of our listeners today, the particular topic that we're going to home in on is respiratory syncytial virus, or RSV. Now, this is a common virus and it usually causes mild cold-like symptoms and most people recover in a week or two. But, Stefania, you have some insights for us on how RSV may affect more vulnerable populations.

Oh yes, in spite of the fact that it has been very often considered primarily a virus affecting children, RSV is a significant contributor to adult respiratory illnesses worldwide and it accounts for more than 10%, for example, of hospitalisation for people with pneumonia, about 12-15% for people with COPD, and also significant increase of hospitalisation for people with chronic heart failure in older individuals. Often it leads to the exacerbation of existing medical conditions, in particular, cardiovascular respiratory diseases, so it is definitely a major burden for older people and for vulnerable people in general.

And when we say older people, what age cohorts are we talking about, and do we see more risk increasing along with age?

Well, usually we consider people over 65. And what I like to underline is the fact that, in spite of the fact that it is true, the prevalence rate increases with aging, it is important to know that comorbidities and frailty are independently associated to an increased risk of infections, of hospitalization and death for RSV. So we have to distinguish between people over 65 who are healthy and community dwelling, and the prevalence rate in this segment of the population is between 3-7%. Then we have increased risk on high-risk people. Therefore, with comorbidities or people with frailty, they increase vulnerability independent of other conditions, and in this population, the prevalence rate can reach up to 12-15%, with an increased risk of requiring medical attention. Up to 50% of them require a visit to the GP and up to 20% might be hospitalised for RSV. And again, in these very vulnerable individuals, the death rate can be up to 5%.

So there are some pretty serious consequences potentially. And if we look at this from different aspects, I suppose first for the individual and the people around them, their immediate family or caregivers, this is quite a big burden of disease. And what can the people who live with them, or you know, what can their community, their close community, do to shield an older or vulnerable person?

Well, you know again another lesson we have learned from Covid is how to use non-pharmacological measures, such as masks, avoiding the close contact with sick people, washing hands very often. And the only problem, Clare, that I think has to be again underlined is the fact that these measures that are essential to decrease the spread of the infection can be very negative in terms of social isolation, increase cognitive decline among older individuals, because if you close, for example, the interaction between grandparents and grandchildren, because children are, of course, vectors of this infection, the well-being and the quality of life of older people is very much affected in a negative way.

Yes, and it's very socially awkward as well, isn't it, to negotiate these issues, using the comparison, of course, with the non-pharmaceutical interventions around Covid? For older people in this community, loneliness was a bigger factor than to be completely shielded from other human beings. But is there a middle way? Or how can a person who is vulnerable protect themselves and explain to the people around them what the most appropriate things to do are?

Yes, the problem with respiratory infectious disease in general in the older people it's based also on the fact that at the beginning the onset of the disease is not with traditional symptoms such as coughing, fever, and sometimes older people have only mild, very mild and atypical symptoms. Sometimes a fall or the sudden onset of delirium can be the first sign sign of a disease. So it is difficult for them, for the caregivers and also for the general practitioner to make a diagnosis. So that's why we insist that we must increase the awareness in the general population, in the caregivers and in the healthcare workers about the risk of this disease and the seasons when there is a high probability and the atypical presentation in older individuals.

And on the issue of kind of greater awareness among healthcare professionals. I mean, Italy has an aging population. Is there a lot of research on how the burden of disease impacts on the public health system? What do we know there?

Well, first of all, in general, in all our countries we must increase the research and particularly the epidemiology of this disease. And this is a must in all our countries because still we need a lot of data on the epidemiology of RSV in older individuals. We know from the data available in Europe, UK, USA, that the impact is very important because when people are hospitalised for RSV, about 10% to 20% of them need the intensive care unit admission, and up to 10% might need medical ventilation. And, moreover, after hospitalisation, the risk of institutionalisation, the need of long-term care increases and also the re-hospitalisation for cardiovascular and respiratory diseases leads, of course, to increased health care cost.

Well, yes, I mean, it's quite a stressor on the public health system and I was going to ask you for my next question do you think public health administrations are adequately prepared? But I have a feeling that I may already know the answer to this one.

Well you know, knowledge is evolving so fast and therefore a close connection between scientists and health policymakers is a must, because, of course, it's a very important topic. I believe that there is a lot that we can do and again we have seen recently, with COVID-19, for example, how important is the digital surveillance system and we don't have in place in most of the countries an appropriate surveillance for RSV. The public administration has to be informed that these systems are necessary to identify patients and to provide them with the appropriate care, considering also the high risk of complications that we have just mentioned. Particularly at this point in time, when we have candidate vaccines and antiviral that are undergoing trials and hopefully they will be available soon we must be able to have a quantitative idea of the dimension of the problem in the community, the burden of the disease in different age groups, and in order to do this we need appropriate surveillance systems.

And is that what you'd most like to see change? I mean, what is the sort of most urgent mission for you, Stefania, to say if there was something that you could wave a magic wand, it would happen in the next three to five years?

Well, yeah, my dream list is to have, first of all, increased warnings among healthcare practitioner, general population and policymakers about RSV infections and how it affects the older individuals beyond the infection itself. The second, of course, would be to strengthen the public health response to the infections, therefore, with the implementation of surveyor systems in most countries and particularly the availability of effectiveness, vaccines and antiviral agents that should finally be available in the next years and hopefully with an equal distribution across countries. That would be a dream.

That is quite a wish list. Stefania, I sincerely wish you the best of luck with making sure that some of those dreams come true. You've been a wonderful guest to ESWI Airborne this morning. I just want to thank you so much.

Thank you, it was a pleasure.

Folks, keep on tuning in to ESWI Airborne, the viral podcast series, for all the latest on pandemics, vaccination, influenza, visualising, viruses and more. You get your news directly from the expert members of ESWI, the European Scientific Working Group on Influenza. Until next time, dear listeners, stay safe.

Aida Bakri: 21:01

ESWI Airborne is brought to you by ESWI, the European Scientific Working Group on Influenza and other acute respiratory viruses. These episodes would not be possible without the team's efforts and we would like to extend special thanks to our ESWI secretariat, our technical and IT teams, our arts team and our host, Clare Taylor. The podcasts are recorded virtually and we thank our guests for their participation in this inspiring series. Talks are adapted to a global audience and are intended to be educational. For any specific medical questions you may have, these should be addressed to your local general practitioner. Many thanks to our sponsoring partners and thank you for listening.

A geriatrician's insight into reducing the burden of disease in older adults

ESWI Airborne: Meet the Members

More info?

ESWI Airborne: Meet the Members