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 researches apparently fail to present more explicit and sounder results. The importance of a premature reduction in response of primary antibodies, observed within the elderly age-group as compared to younger individuals is another highly disputed topic. Furthermore, both lines of approach display acute methodological failings, namely, disparity in influenza case definition, application of diverse clinical endpoints, probable bias impacting influenza efficacy estimations (inclusion of subjects suffering from conditions impacting immune response, already vaccinated individuals, and individuals depicting high titers before inoculation) and poor protection correlates within immunogenicity research (Lang et al. 2012).

Identification of Themes across Studies

Shared research themes include: well-matched influenza vaccines helped prevent hospitalization, pneumonia, and pneumonia or influenza related mortalities; well-matched influenza vaccines helped prevent pneumonia and influenza linked hospitalization as well as all-cause death; and following confounder adjustment, improved vaccine efficacy was observed for pneumonia/influenza, cardiac and respiratory ailment hospitalizations as well as all-cause deaths. Further, outcomes revealed that immunization proved most effective in case of people residing within institutional settings; modest vaccine efficacy was noted within community settings (Lang et al. 2012).

Comparative Evaluation of the Evidence to Practice

Comparison of Findings with Personal Practice/Literature

Every meta-analysis that reviews influenza vaccine efficacy estimations has raised questions regarding existing information’s quality and inference. Bias within literature might be wholly or partly responsible for influenza vaccine success estimates. An evaluation of mortality risks from all cause and influenza/pneumonia-linked hospitalizations with regard to inoculation in time periods prior to, in the course of, and following influenza spells outcomes suggested preferential vaccine receipt by fairly healthier elderly individuals. Also, the bias wasn’t controlled for by the help of comorbid disease adjustments. Lastly, functional limits including need of bathing assistance link to lower immunization probability, even among elderly individuals without any comorbid issues (Lang et al. 2012).

Additional findings gleaned from a research revealed that following risk factor adjustment (age, self-reported wellbeing and health, and chronic problems) mortality prior to, in the course of, and following 9 seasons of influenza outbreak increased similarly with time among healthier persons as well as high-risk subgroups. All of the above findings offer sound evidence of the fact that selection-related bias constitutes a serious flaw among a large number of observational estimates among aged persons. The outcomes fail to offer valid evidence for estimating the actual advantages of influenza immunization programs.

Feasibility of Changing Practice

For differentiating between vaccine impacts and bias, an approach of “difference in differences” is put forward. That is, if the vaccine for influenza was actually capable of preventing mortality, large populations ought to exhibit obvious differences between the disparity in earlier immunization probability between survivors and decedents noted during influenza spells and the variance in earlier immunization probability between survivors and decedents anticipated on those very calendar dates when there is no influenza outbreak (Lang et al. 2012). According to Darvishian et al. it would require creation of a new bias-adjustment method that increases the assessors and puts in place empirical evidence (2014). Ideally, once potential biases are addressed, the vaccination is estimated to effectively prevent hospitalizations due to influenza among the elderly (Darvishian et al. 2014).

A more significant change will be observed when novel strategies exist for improving influenza vaccine efficacy estimate accuracy. Further research ought to encompass examination of weaknesses and strengths of multiple comparison intervals to validate the model, impact of key probable confounders, and alternate means (e.g., sensitivity analyses) of quantifying the effect of likely residual confounding. Complementarily, bias reduction approaches ought to encompass the acquisition of more correct and precise confounder data (including life expectancy and functional status), preventing all-cause mortality for results like influenza-linked or non-linked pneumonia and potential determination of influenza-specific results for improving research sensitivity for identifying true vaccine impact (Lang et al. 2012).

Barriers to Change: Perceived or Real

But precise additional mortalities to winter season mortalities ratio that may be ascribed to influenza proves hard to compute, on account of an absence of existing individual-level measures. The ratio employs a numerator underrating influenza-linked mortalities from a difficulty in realizing actual influenza burden; meanwhile, the denominator overvalues influenza season mortalities. Consequently, the ratio fails to correctly reflect influenza-linked absolute death burden, and hence, proves misleading in gauging influenza immunization death-rate benefit plausibleness. Hence, a “controversy” is raised out of questions pertaining to whether or not observational research bias and residual confounding have generated influenza vaccine efficacy estimates misjudging actual benefits. In the absence of intense change, present adjustment techniques will fail to appropriately control for biases; the aforementioned controversy will, thus, certainly persist (Lang et al. 2012).

Summary

Restatement of key findings

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. Growing influenza-related hospital admission and mortality rates in recent decades despite appreciable growth of influenza vaccine coverage in aged persons contrasts greatly with early inoculation benefits for this group. The study finds a lack of techniques capable of effectively tackling bias which interferes with influenza vaccine efficacy measurement accuracy (Lang et al. 2012).

Implications for Practice/Research

The study calls for an improved grasp of interference of vaccine response in age-linked change and their interface with commonly occurring chronic comorbid problems. Additionally, for validating future immunological therapy and influenza vaccines that increase protection among the elderly within head-to-head clinical trials, no reference point exists against which aging effects on influenza vaccine response may be predicted. Furthermore, although immunosenescence unquestionably interferes with immune system capacity when it comes to responding effectively to vaccination, individual responsiveness predictions by utilizing sound biological markers which differentiate between immunosenescent and healthy states is desirable as well (Lang et al. 2012).

References

Darvishian, M., Gefenaite, G., Turner, R. M., Pechlivanoglou, P., Van der Hoek, W., Van den Heuvel, E. R., & Hak, E. (2014). After adjusting for bias in meta-analysis seasonal influenza vaccine remains effective in community-dwelling elderly. Journal of clinical epidemiology, 67(7), 734-744.

Dawood, F. S., Prapasiri, P., Areerat, P., Ruayajin, A., Chittaganpitch, M., Muangchana, C.,… & Olsen, S. J. (2014). Effectiveness of the 2010 and 2011 Southern Hemisphere trivalent inactivated influenza vaccines against hospitalization with influenza-associated acute respiratory infection among Thai adults aged≥ 50 years. Influenza and other respiratory viruses, 8(4), 463-468.

Dominguez, A., Soldevila, N., Toledo, D., Godoy, P., Castilla, J., Force, L.,… & Martin, V. (2016). Factors Associated with Influenza Vaccination of Hospitalized Elderly Patients in Spain. Plos one, 11(1), e0147931.

Fry, A. M., Kim, I. K., Reed, C., Thompson, M., Chaves, S. S., Finelli, L., & Bresee, J. (2014). Modeling the effect of different vaccine effectiveness estimates on the number of vaccine-prevented influenza-associated hospitalizations in older adults. Clinical Infectious Diseases, 59(3), 406-409.

Goldstein, E., Greene, S. K., Olson, D. R., Hanage, W. P., & Lipsitch, M. (2015). Estimating the hospitalization burden associated with influenza and respiratory syncytial virus in New York City, 2003 — 2011. Influenza and other respiratory viruses, 9(5), 225-233.

Lang, P. O., Mendes, A., Socquet, J., Assir, N., Govind, S., & Aspinall, R. (2012). Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence.

Matias, G., Taylor, R. J., Haguinet, F., Schuck-Paim, C., Lustig, R. L., & Fleming, D. M. (2016). Modelling estimates of age-specific influenza-related hospitalization and mortality in the United Kingdom. BMC Public Health, 16(1), 1.

Get Professional Assignment Help Cheaply

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

• Plagiarism free papers
• Timely delivery
• Any deadline
• Skilled, Experienced Native English Writers
• Subject-relevant academic writer
• Adherence to paper instructions
• Ability to tackle bulk assignments
• Reasonable prices
• 24/7 Customer Support
• Get superb grades consistently

Online Academic Help With Different Subjects

Literature

Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.

Finance

Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!

Psychology

While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.

Engineering

Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.

Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.

Sociology

Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.

Business

We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!

Statistics

We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.

Law

Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

• When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
• We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

• The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
• We will have a different writer write the paper from scratch.
• Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY!!!