Infectious Disease Preparedness and Support for Older Adults Experiencing Homelessness

The Centers for Disease Control and Prevention (CDC) recently announced the United States is experiencing another wave of respiratory illnesses, with flu hospitalizations reaching their highest level in a decade, COVID-19 cases climbing, and respiratory syncytial virus (RSV) impacting older adults.

According to CDC Director, Dr. Rochelle Walensky, hospitalizations for all three illnesses are overwhelming healthcare systems, and colder weather and indoor gatherings are likely contributing factors. She also acknowledged flu vaccination rates are down among older adults. In addition, although various vaccines and antiviral treatments are being studied, a vaccine for RSV does not exist. The risk of adverse outcomes from RSV is especially high among older adults: in the United States each year, it is estimated that between 60,000 to 120,000 older adults are hospitalized and 6,000 to 10,000 die due to RSV infection. With so many illnesses circulating, it’s important for homeless service providers to prepare themselves for how this may impact the older adults they serve.

Why Are Respiratory Illnesses More Dangerous for Older Adults?

Respiratory illnesses are more dangerous for older adults for a few reasons. One reason is the immune system, which helps the body fight infections, weakens with age. It is typical to pick up a secondary infection like pneumonia while the body is busy fighting off the flu. Older adults are also more likely to have other health conditions, like diabetes, which increases their risk for complications from the flu. People 65 years and older are at higher risk of developing serious flu complications. While flu seasons vary in severity, during most seasons people 65 years and older bear the greatest burden of severe flu disease. Although RSV is a common seasonal virus with cold-like symptoms that is distinct from influenza, it can cause pneumonia and death in the old. The National Foundation for Infectious Diseases has published a resource on how clinicians and other stakeholders can inform themselves and protect the people they serve: “Call to Action: Reducing the Burden of RSV across the Lifespan” is available on its website.

Implementing Infection Precautions in Congregate Settings

With homeless shelters as likely sites for transmission of airborne pathogens, managing the spread of infectious diseases remains a challenge. And as many communities return to traditional congregate model shelters and implement their hypothermia programs, people they serve, especially older adults and those with chronic medical conditions, are at increased risk. Therefore, it is even more important that homeless services providers employ infection prevention and control practices. This, according to Dr. Walensky, includes wearing a mask where community viral transmission is high.

Infection prevention and control practices are important to keep all staff, volunteers, guests, and residents healthy and well. Infectious diseases, such as the flu, COVID-19, and RSV can spread quickly without adequate infection prevention and control measures in place.