‘We are failing older people’

fluvaccinesCivil society organisations must do more to put adult vaccination on the healthy ageing agenda.

Too few people know the adult vaccine schedule and fewer still have the immunisations that can help them to live longer, healthier, active lives, according to Dr Jane Barratt, Secretary General of the International Federation on Ageing (IFA).

"The question is: have we failed older people in the conversation about healthy ageing by neglecting vaccine preventable diseases?" The answer, said Dr Barratt, is an unequivocal ‘yes’.

Speaking at a symposium on adult immunisation during the International Association of Gerontology and Geriatrics European Region Congress in Dublin, she said people have a right to good health – including access to vaccination – and unless civil society organisations put it on their agendas this right will not be protected.

Dr Barratt said her organisation is keen to explore why adult vaccination rates are low so that measures can be taken which could help to reduce vaccine-preventable diseases in older people.

"We need to understand how to protect the rights of older people. Adult immunisation is one area that hasn’t had the focus that it deserves."

Some older people opt out of immunisation out of complacency: ‘Is it really worth having the flu or pneumococcal vaccine?’ ‘Am I really at risk of shingles?’

Real risks

Yet the risks are real. Pneumonia increases the chance of heart attack and stroke in older adults, Dr Barratt noted. "The risk of having a cardiovascular event is four times higher in the 30 days after having pneumonia. The risk remains 1.5 times higher even one year after a bout of pneumonia."

Achieving 75% uptake of flu vaccines would prevent 3.8 million cases of flu worldwide; save 97,000 people from being admitted to hospital; and prevent 51,500 deaths.

Shingles too can have a real impact on quality of life. Around one in four people aged 50 years or older will develop herpes zoster. Of these 90% experience moderate to severe pain and one in five develop post-herpetic neuralgia – a form of intense nerve pain which can be long-lasting and disrupt sleep.

Sharing good practice

While the uptake of recommended adult vaccines is unsatisfactory around the world, there are plenty of examples of how to increase immunisation rates:

  • A computerised vaccination register used in the Murcia Region of Spain identifies at-risk patients and ensures that they are notified. Once the vaccine is given to the patient, this is recorded by the health professional and the regional system is updated.
  • The Brooklyn Hospital Center has prioritised improving immunisation rates among its patients. They have a ‘morning huddle’ every day to ensure they have the vaccine stock and the staff to provide vaccinations and they check patients’ records in advance of their visit to see what vaccines might be relevant for their age group.
  • Researchers at the University of Pittsburgh developed what they call ‘The 4 Pillars Immunization Toolkit’ for primary care practices. Using this approach, influenza and pneumococcal vaccination rates can be significantly increased.

The Happy Ageing project in Italy is an alliance of clinical scientific, political and social groups committed to healthy ageing. The group focuses on five areas: exercise, healthy eating, screening and prevention, medication, and immunisation.

Valuing life

"We cannot celebrate longevity when our quality of life is compromised – that’s why we need preventative strategies," Dr Barratt told the symposium.

There may also be an unspoken ageism at play which puts a lower value on keeping adults healthy than it attaches to children’s health. Yet, healthy older people are more active than ever before: they work longer, they volunteer in their communities, and they share the burden of childcare in their own families. "The role of grandparents is critical. But if you are in hospital with pneumonia that role is compromised," said Dr Barratt.

This message was echoed by Stephen McMahon, CEO of the Irish Patients Association and Interim CEO International Association of Patient Organisations (IAPO), who chaired the event.

"When we think about children being vaccinated there is an immediate empathy – nobody wants children to die of preventable diseases," he said. "But people of all ages are at risk of diseases for which we have vaccines."

He said governments and all other stakeholders need to do more on this issue. "We must not accept that old age brings with it less access to a full range of human rights," said Mr McMahon.

Wanted: vaccine champions

Dr Barratt said immunisation needs champions and acknowledged that adult vaccination was not on her organisation’s radar until she was asked, at the last minute, to speak on the topic at a conference in 2010. "I was ashamed to say that this topic just was not on our agenda."

It was a wake-up call she wants to share with others. The IFA is hosting an advocacy summit in June where it hopes to rally health professionals, patient groups, educators and families to get behind life-course immunisation. The goal is to create a cohort of immunisation advocates, champions and mentors who will bat for immunisation in medical faculties, in public and in policy debates.

"Immunisation can slip through the gaps between ministries. Nobody is holding onto it," she said. "We have to step up. This is an issue for everyone. We need a ‘surround sound’ approach."

"We often speak about health equalities but we cannot have equality if we are not actively working to improve immunisation for everyone," said Dr Barratt.