Functional Decline - CARP

Influenza, or the flu, is a highly contagious and infectious respiratory disease. Common flu symptoms include fever, cough and muscle aches and pains. Other common symptoms may include headache, chills, fatigue (tiredness), loss of appetite, runny or stuffy nose, and in some cases, diarrhea, nausea and vomiting.

As we age, our immune systems weaken, making it easier to get sick and harder to fight off infections. This is called immunosensecence, a gradual slowing down of the immune system due to aging. This makes Canadian adults, aged 65 and older, at a high risk of flu and serious flu-related health complications and long-term diminished functional ability.

Canada continues to lag behind their goal of 80% vaccination rate for adults aged 65+, with only 70% of older adults receiving an influenza vaccination in 2019.

Influenza contributes to an average of 12,000 hospitalizations and 3,500 deaths in Canada each year, with adults aged 65 and older accounting for 70% of influenza-related hospitalizations.

Influenza and pneumonia were the 6th leading cause of death in Canada in 2019, with older adults accounting for 90% of influenza-related deaths.

Other health complications for adults aged 65 and older resulting from the flu include:

  • Increased risk of heart attack by 3-5x in the first 2 weeks of infection.
  • Increased risk of stroke by 2-3x in the first week of infection.
  • Worsening of existing chronic health conditions.

Outside of these physical health implications, the flu can have lasting impacts on everyday functioning and independence. Hospitalization as a result of the flu can impact older adults’ ability to live independently, due to functional decline.

Functional decline is a loss of independence, often associated with a deterioration in mobility and a decline in ability to participate in a variety of activities of daily living.

These are the meaningful activities we perform every day and can include:

Self-Care -Preparing meals, dressing, ambulating, toileting, personal hygiene (bathing, brushing hair/teeth, etc.)

-Money management, medication management, driving.

Productivity -Ability to attend work, volunteering, participate in parenting or care-giving roles
Leisure -Community mobility and social isolation.


Functional decline occurs naturally as we age, however it can occur rapidly during hospitalization. Studies show that 1/3 of adults leave the hospital with functional decline and inability to perform important daily activities. This functional decline is often difficult to reverse and may result in long-term loss of independence, social isolation and reduced quality of life.

The best way to protect yourself from the flu and functional decline as a result of the flu is through VACCINATION!


1. Get your flu vaccination annually– Even if you have already been sick! Try setting up a yearly reminder in your phone or on your calendar to get vaccinated.

  • Note: it is important to get the flu vaccine every year because the virus is constantly changing.   A new vaccine is developed each flu season.


2. Ask your doctor about the high-dose flu shot: Fluzone High-Dose vaccine has 4x more antigens (the inactive virus that promotes the immune response) than regular flu shot and has been shown to be 24% more effective in preventing the flu in older adults.

  • Read more about the high-dose flu shot here. The high dose flu vaccine in Canada is currently only being offered by primary physicians and not in pharmacies.
  • Click here to see if the high-dose flu shot is covered in your province.


3. Get vaccinated early! It takes your body two weeks to build up immunity after the flu vaccine. Get vaccinated by the end of October before flu season starts.

  • Vaccinations in July/August are too early and associated with decreased immunity from influenza.


4. Check your immunization status! Make sure you are up to date on all your current vaccinations.

    • Pneumonia is a serious flu-related complication. The pneumococcal vaccine is recommended and available for adults aged 60+ in Canada.
    • Download an immunization record on and bring it with you to your doctor’s office to make sure you are up to date. Click here to download the immunization guide.
    • Click here for tips on how to access  your immunization records.

Other tips

  • Practice proper hand hygiene! Wash your hands regularly using soap and warm water for 20 seconds to help prevent the spread of influenza.


  • Avoid touching your face! Avoid touching your mouth or nose with your hands when out in public.


  • Exercise Regularly! Exercising at a low to moderate frequency is beneficial for your health and also has been show to lower influenza-associated mortality.


  • Sign up to become a FluWatcher! Help monitor the incidence of the flu and flu-like illness in Canada and receive up to date information regarding spread of flu in your community!


Click Here to learn more about FluWatchers.


Click Here  for a Step-by-Step to  Become a FluWatcher.


Most people recover from the flu in 7 to 10 days, however fatigue and weakness may last for up to 3 weeks or longer in people with chronic disease or weak immune systems.  The Public Agency of Health Canada recommends:

  1. Notify your health care provider immediately if you are experiencing flu-related symptoms and tell them about your symptoms before attending an appointments.
    • Click here for list of symptoms associated with cold and flu and how to tell the difference.Stay home and avoid close contact with other people until you are able to return to day-to-day activities.
  2.  Rest and drink lots of fluids.
  3. Take over-the-counter medication, as recommended, to manage symptom
  4. Contact your doctor if you develop any of these serious symptoms: shortness of breath, rapid breathing or difficulty breathing, chest pain, bluish or grey skin colour, bloody or coloured mucus/spit, sudden dizziness or confusion, severe or persistent vomiting, high fever lasting more than three days, low blood pressure.

Research suggests that one of the most important factors associated with functional decline is the number of days off from regular activity, with more days off associated with a greater decrease in decline.

1. Keep Mobile! If it is safe and you able, try to keep mobile and continue to perform tasks you are usually able to do while recovering from the flu.

    • For example, this could include getting up and getting dressed in the morning or walking around your house with or without assistance.


2. Avoid being “catered to.” If it is safe, continue to do the activities you are usually able to do independently.


3. Attempt getting out of bed. If it is safe and you are able, getting out of bed can help to prevent bed sores and loss of strength, and improve mood, sleep, circulation, and breathing.


4. Stay social! Staying at home while recovering from illness doesn’t mean we can’t socialize. Try a phone call, Zoom or Facetime to stay connected with family and friends.


5. Maintain a healthy diet! Maintaining a healthy diet is an important aspect of preventing functional decline. If you are able, continue to prepare meals, or ask a family member or friend for support. Community programs, like Meals on Wheels, are also available to provide nutritional support to older adults who are convalescing from surgery or illness.


6. Manage any chronic conditions. The flu can exacerbate chronic conditions, resulting in increased likelihood of complications from the flu and hospitalization (and therefore further functional decline). Staying on top of your medications and doctor visits can help to manage chronic conditions and reduce risk of functional decline.


7. Be aware of your environment. Acute illness and hospitalization increase falls risk. Always ensure you are wearing proper footwear in your home and be aware of your home environment- such as clearing cluttered hallways.

• The cold and the flu can have similar symptoms, both come from a respiratory tract infection, in the nose, sinus and throat. The difference is in how intense they feel and how common they are. In general, symptoms of the flu occur quickly (especially fever and chills), while symptoms of a cold happen slowly (symptoms build over 48 hours. An important difference is that the flu can be prevented. Make sure to get your flu shot!


May feel chills, but fever is rare
Cough, chest discomfort (mild but may last a while)
Body aches and pains (mild)
Tiredness (You can still do your daily activities)
Headache (mild)
Sore Throat
Stuffy, runny nose, sneezing


Cough, chest discomfort (dry cough can be severe)
Body aches and pains (can be severe)
Bedridden (you may feel exhausted)
Headache (Can be severe)
Sore throat
Stuffy, runny nose