Improving immunizations for older people

The Advisory Committee on Immunization Practices recommends multiple immunizations for older adults, including flu, two pneumonia vaccines, vaccination against herpes zoster, and a one-time tetanus, diphtheria, and pertussis vaccine. The Centers for Disease Control and Prevention estimates that 63% of annual hospitalizations, and 90% of influenza-related mortality, occurs in people over 65.

Fortunately influenza vaccinations can prevent hospitalizations related to respiratory illness and even more importantly, vaccination may prevent an increased risk for stroke and myocardial infarction that occurs following the flu. Despite the benefits associated with vaccinations, vaccination rates are still too low. The November 2017 flu vaccination coverage rate was only 56.6% for those over 65. For people between 50 and 64 the rate was only 40.6%.

In order to increase adherence to adult immunization recommendations across the country the Gerontological Society of America developed the Immunization Champions, Advocates and Mentors Program, a step-by-step guide to vaccinating adults. The program was developed based on the fact that education of providers or patients alone does not seem to change immunization behavior. Instead the Gerontological Society decided to focus on developing immunization advocates to champion better immunization behavior.

The Gerontological Society believes that in order to really increase vaccination rates for all adults it is important to try to change actual immunization behavior. Specifically, doctors should provide ongoing encouragement and education, getting rid of the unpleasant sensations associated with getting immunized such as fear and pain, and also improve incentives, to encourage patients to get immunized. We also encourage focusing on changes in the environment and policies within settings to help engage staff and patients in getting immunized.

Facilities were provided with material to help champions assess the immunization status of all patients, share educational materials with patients, give examples of ways to strongly recommend appropriate vaccines and motivate patients and other providers to give immunizations, ways in which to safely administer vaccines or refer patients to another provider for the vaccines, and the appropriate way in which to document and report administered vaccines. Motivational techniques and role playing were a major component of the training and addressed cultural sensitivity and issues and ways to manage all of the excuses and negate the myths associated with immunizations. For example, we strongly encouraged the providers to recommend vaccines using a presumptive statement. An example of this is: “It’s time for your flu shot. We’ll give it to you today;” or “Flu season is coming, and we need to immunize you against influenza. We’ll give it to you right before you see the provider today.”

The Gerontological Society of America National Adult Vaccination Program provides training on how to make immunizations happen. Along with developing champions, health advocates believe that it’s important to make immunizations more accessible and that providers use presumptive statements to encourage vaccinations. Providing immunizations in the workplace and for people living in assisted living, nursing homes, or other institutions is critical to improving overall immunization rates.

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