Tweet

Dr Kate Miller

20 May, 10 tweets, 5 min read

Up now at #ANZSGM2021: Vaccination considerations in the elderly. Professor Michael Woodward. Disclosure: Sponsored by GSK #geriatrics

Possible modulators of age-related decline in immunity
- mediteranean diet preferred: vegetable and fish sources of protein in preference over animal protein
- caloric restriction
#ANZSGM2021 Professor Michael Woodward #geriatrics

Shingles: VZV specific t-cells decline with age (starts around 50), drop below the threshold to develop shingles. 15% of people will suffer a neurological event ie stroke in those who have zoster opthalmicus.
#ANZSGM2021 Professor Michael Woodward #geriatrics

Postherpetic neuralgia common - up to 30% of patients. Can persist for years, age is strongest risk and prognostic factor. Dissemination can occur in older people due to the immunocompromise of old age. Mortality 5-15% #ANZSGM2021 Professor Michael Woodward #geriatrics

BPI - Brief Pain Inventory that assesses impact of post herpetic neuralgia on life. Lots of agents to treat pain - but in the interests of reducing polypharmacy, prevention is a much better option. #ANZSGM2021 Professor Michael Woodward #geriatrics

Live zoster vaccine added to immunisation schedule 4.5 years ago. New recombinant vaccine came out in 2018. Live vaccine on schedule to be given at age 70. Recombinant or live can be sought privately. #ANZSGM2021 Professor Michael Woodward #geriatrics

Efficacy of live VZV vaccine aged 50-59 around 70%, drops to 51% aged 60 and continues to drop (as with most vaccines in older people). But still confers some protection and may prevent post-herpetic neuralgia. Less data available in older people for a recombinant vaccine.

SEs: Local erythema, pain, itch, less common: headaches. #ANZSGM2021 Professor Michael Woodward #geriatrics

New recombinant vaccine, up to 70% efficacious in pooled studies. TGA approved. Not live so can be used in immunocompromised. As effective at prevention of postherpetic neuralgia as it is preventing disease. Significant SEs are fatigue and myalgia. Needs 2 doses. #ANZSGM2021

Uptake of flu vaccine is about a TENTH of what it was last year, please tell your patients to get their flu vaccine. Don't give it with the shingles vaccine. #ANZSGM2021 Professor Michael Woodward #geriatrics

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @DrKate_Miller

Dr Kate Miller

@DrKate_Miller

21 May

Alright, a tweet series on what I currently think about the AZ vaccine. This is NOT medical advice, I am not an expert by any means, I don't have the same access to data that the public health guys do, I'm just a geriatrician trying to figure this out too in an info vacuum.

So before you get stuck into me about being a murderer/playing god/being Bill Gates drone...just don't. I'm not here to shame anyone, I'm here to discuss. Whatever you choose, based on your own personal circumstances, is just fine.

In 800 AD smallpox had wiped out millions. Chinese doctors discovered that by taking scrapings of smallpox and pipetting it up peoples noses, they could prevent smallpox. The fatality rate of this was a whopping 1%. People still took it; the smallpox death rate was 35%.

Read 25 tweets

Dr Kate Miller

@DrKate_Miller

21 May

Roots of geriatric medicine stretch back 5000 years ago, in the Nile Valley, Egypt. Demonstrating a hieroglyph for the world 'old'. It's a bent over person with a gait aid! #ANZSGM2021 Dr William Browne - The Unexpected History of Geriatric Medicine

(I am loving this talk SICK). Ptah-Hotel 2000 BCE - "Old age makes a man miserable". #ANZSGM2021 Dr William Browne

Ancient Greek depiction of 'Geras' the god of old age - the root of the word geriatric. #ANZSGM2021 Dr William Browne

Read 24 tweets

Dr Kate Miller

@DrKate_Miller

20 May

Alcohol related Korsakoffs disease is most likely non-progressive. Of those who do, there is probably an additional underlying disease process. #ANZSGM2021 Assoc. Professor Dr Steven Macfarlane #geriatrics #medtwitter

Discussing people with dementia who have Brodaty Tier 5-6+ behaviours and the role of Specialist Dementia Care Units. More info here: health.gov.au/initiatives-an…
#ANZSGM2021 Assoc. Professor Dr Steven Macfarlane #geriatrics #medtwitter

SDCP: behaviours need to be refractory to management by a specialist or specialist service. Behaviours might flare but if they are addressed by a geriatrician/psychogeriatrician or other specialist service and allowed to settle, then they will not meet criteria. #ANZSGM2021

Read 7 tweets

Dr Kate Miller

@DrKate_Miller

19 May

The very excellent Dr Clare White (and my former boss!) from Western Health up now on the COVID-19 response in aged care last year. #ANZSGM2021 Dr Clare White

Early: Lack of agreed on protocols across the country with onus placed on providers to be prepared. This overestimated the level of expertise in aged care to manage this especially with RC going on! Not enough focus on aged care, more on ED/ICU. #ANZSGM2021 Dr Clare White

Western Health and Melbourne Health carried the whole cluster due to the structure of regional hubs (as opposed to a single hub) 👏👏👏👏 #ANZSGM2021 Dr Clare White

Read 10 tweets

Dr Kate Miller

@DrKate_Miller

19 May

What went wrong in residential aged care last year in Victoria? Broadly: Governance, leadership and communication. Furloughing large swathes of staff caused critical failures. - no one available to provide primary care. #ANZSGM2021 Professor Michael Murray

Inreach geriatricians saved people by providing basic care in residential aged care as a result. 👏👏👏👏👏 Hospitals were focus of all thankyou gifts etc - nothing given to residential aged care staff looking after their covid residents. #ANZSGM2021 Professor Michael Murray

"We will never get some of these people back into this industry. We never demonstrated that we gave a toss". Some facilities received death threats. Hospitals? Nothing. #ANZSGM2021 Professor Michael Murray

Read 5 tweets

Dr Kate Miller

@DrKate_Miller

18 May

Professor Sharon Lewin @ #ANZSGM2021 (paraphrased): Clotting syndrome of AZ now less concerning now that we know how to rapidly identify and treat it, in addition to the point that it is very very rare.

Rationale for giving it to older Australians is that it's even more rare in their age group. We are NOT safe to avoid vaccination because of current low community transmission. If we have an outbreak (and highly possible we will), no one is protected. #ANZSGM2021

On variants: Calling variants by country name ie UK variant, Indian variant etc is unfair, as this is simply where the variant was first identified, not where it originated. #ANZSGM2021

Read 5 tweets

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!