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Release: July 6, 1999

UI study indicates many older adults still not receiving recommended vaccinations

IOWA CITY, Iowa -- Many older adults still do not receive flu and pneumococcal vaccinations despite their proven safety and effectiveness in helping some elderly people-- especially those with chronic medical conditions -- avoid more serious illness.

These findings come from University of Iowa Health Care researchers who interviewed nearly 800 older Iowans to determine what factors were associated with getting the vaccines.

"Vaccinations are one of the best preventive health measures around, yet I'm always surprised that they are not more widely used," said Bradley Doebbeling, M.D., UI associate professor of internal medicine and preventive medicine and environmental health, and the study's senior author. "We were interested in finding out more about who's receiving their shots among this specific segment of the population. I think our results show that there is room for improvement."

The researchers studied 787 Iowa adults, selected at random from both rural and urban areas, who were age 65 or older and who had one or more chronic conditions such as arthritis, diabetes, heart or lung disease, or hypertension. Participants were asked about their current health practices, marital and occupational status, and access to health care.

Of the 784 subjects who provided complete influenza vaccination information, 68 percent reported getting the flu vaccine in the past year. Of the 768 people who provided complete pneumococcal vaccination information, 51 percent reported having received it. Forty-four percent of the study participants reported receiving both vaccines.

Doebbeling said the numbers are "certainly lower than we'd like to see. This is a group of people who actually have two strong indicators -- being age 65 or older and having a chronic health problem -- for getting these vaccines. This is a group that we should be targeting for vaccination in the 90 to 100 percent range," he said.

Study results showed that people age 70 or older were more likely to get the vaccinations, as were those who were still married or did not live on their own. Study participants age 65 or older who were still working were more likely to be immunized, as were people who had more contact with the medical system -- doctor visits, prescription drug use or a number of underlying chronic illnesses. The researchers found no significant disparities between rural and urban residents in the study in terms of who had received the vaccines.

Insurance issues also affected whether study participants received vaccinations. Since all of the study participants were age 65 or older, they were all covered by Medicare. However, supplemental insurance in addition to Medicare nearly doubled the likelihood of study participants getting both vaccines. Doebbeling noted that Medicare coverage of the flu vaccine apparently has resulted in an increase in its usage, and Medicare coverage of the pneumococcal vaccine has only recently been provided.

Influenza and pneumococcal vaccinations have tremendous benefits for older adults, Doebbeling said. Both vaccines have been around for a number of years, are safe and have few, if any, side effects. Flu shots among the elderly decrease mortality by about two-thirds if an older person does get the flu. The flu vaccine is recommended yearly and for those who get it every year there is even greater efficacy because the body has built up antibodies to a panel of flu viruses. He added that the pneumococcal vaccine helps prevent against a range of infections caused by Streptococcus pneumoniae. In the United States these include about 3,000 cases of meningitis, 500,000 cases of pneumonia and nearly 7 million cases of ear infection each year.

The bottom line, Doebbeling said, is that both older people and health care providers need to think about increased use of both influenza and pneumococcal vaccines, particularly if a person is over 65 or has a chronic condition. People should always be advocates for their own health care and feel free to ask their physician about the vaccines.

"Physicians do a good job focusing on the patient's immediate health complaints, but prevention issues do not always get covered," Doebbeling said. "These are simply missed opportunities. Hopefully, this study will be a stimulus for both patients and providers to think about the benefit that these vaccinations provide."

The UI study was published in the May issue of the journal Medical Care.