Vaccines can protect older people from several infectious diseases, helping them to stay healthy in later life. However, adult vaccination has generally received much less attention than infant immunisation.
That changed – at least for a time – during the Covid pandemic, when older people were a top priority for pandemic immunisation programmes. The urgent need to engage with adults on vaccination revealed gaps in public awareness about vaccines, but it also highlighted the limits of healthcare professionals’ experience in discussing immunisation with this group.
The EU-project, Vaccinating Elderly for Healthy Ageing (VITAL), has developed and curated educational resources to help healthcare professionals communicate with older people about vaccinations. Prof Aura Timen of Radboud University Nijmegen in the Netherlands led the development of the VITAL Educational Platform which provides clinicians with videos and infographics to support them in protecting their adult patients.
‘This project began by examining the evidence on how to communicate about adult vaccination. We found that most of the available literature was designed for immunisation programmes for children and adolescents,’ Prof Timen told Vaccines Today. ‘So, we asked older adults for their perspectives on what they need to make informed decisions, and spoke to healthcare professionals about their needs.’
Older people said they wanted more information about vaccines and the diseases they prevent. Some had questions about the need for vaccination and how vaccination works. For clinicians, there were gaps in scientific knowledge, but also a lack of training on how to have conversations with older people and how to handle vaccine hesitancy.
‘We started working on this project in 2019. Then the Covid pandemic began and there was a lot of wider discussion about engaging with adults,’ says Prof Timen, who was one of the leaders of the Netherlands’ pandemic response. Following that high profile role, she is now Professor of Primary and Community Care at Radboud University where, among other things, she is exploring how the lessons of the pandemic can shape a healthier future.
So, what did the pandemic teach us about vaccine communication to older adults?
‘One size does not fit all,’ Prof Timen says. ‘That applies to older people, but also to healthcare professionals.’
A wide range of professionals interacts with the population, advising or administering vaccination. This includes GPs, geriatricians, pharmacists and community nurses. Even those who do not give vaccines may be asked about vaccination.
‘All have a role to play,’ she says. ‘It is a network activity rather than just a one-on-one interaction between a single clinician and an individual.’
The adult population is also diverse, meaning that no single message or communication approach will suit every situation. ‘Older adults have a variety of attitudes to the role of vaccines in healthy ageing. That’s why clinicians sometimes adapt their communication strategies to meet the needs of the patient.’
Prof Timen points to three common approaches to discussing immunisation with older people. ‘Some healthcare professionals embark on these interactions with the goal of convincing old adults: they advise the patient to accept vaccination. Others sit back and wait until older adults come to them with a question. And the third group takes a hybrid approach, adapting to meet the needs of the patient.’
Deciding which approach to take is a matter of judgement, but training can help. ‘The best approach is the one that suits the individual patient. It’s important to meet the patient half way; to understand what their needs are.’
The value of equipping healthcare professionals with tools and training can be seen in the high levels of trust older people express in their healthcare providers. Prof Timen says provider recommendations are ‘the most important driver in decision-making’ about vaccination, but she notes that the emergence of distrust in authorities since the pandemic has strained trust in vaccines. ‘Despite this, healthcare professionals remain crucial and can make a real difference,’ she adds.
The VITAL Educational Platform provides accessible summaries of existing resources, with the addition of original videos which address key topics such as how to talk about vaccine hesitancy. Prof Timen says she would also like to see more material on adult vaccination included in medical school curriculum and in continuing medical education programmes. In the context of healthy ageing, the role of vaccines will continue to grow so professionals need to be prepared.
‘There are benefits of vaccines beyond preventing the symptoms of infectious diseases. This has been overlooked for too long,’ she adds. ‘We see the rising burden of diabetes, for example, but we know that vaccination protects against complications and comorbidities. And there are very exciting discussions happening about the role of immunisation in reducing overall risk of neurodegenerative diseases.’
Looking ahead, Prof Timen says the VITAL project is part of a wider effort to incorporate immunisation into healthy ageing. ‘I believe we should look at where the benefits of vaccination might be highest,’ she adds. ‘It would be wise to think not only about the oldest adults, but also about the public health gains that could come from vaccinating adults earlier in the ageing process: people who are fifty plus, not just seventy plus.’
What vaccines are available to older people?
Immunisation programmes can vary from country to country. Check your national schedules to learn more about what is recommended and/or reimbursed where you are. These are some of the vaccines offered in several European countries.
- Influenza vaccine: most European countries offer annual flu vaccines to people over 60 or 65.
- Pneumococcal vaccine: several countries recommend protecting against this bacterial infection which can cause pneumonia, meningitis and septicaemia.
- COVID-19 vaccine: recommendations can vary depending on age and individual risk (e.g. people with underlying medical conditions).
- Respiratory Syncytial Virus vaccine: RSV vaccination is offered to older people in a growing number of European countries. It is also recommended in some places for pregnant women. Check with your local providers.
- Herpes Zoster vaccine: protects against shingles and is reimbursed in some countries.
- Diphtheria, Tetanus, Pertussis (dTp) vaccine: most, but not all, european health authorities recommend boosters in adults to prevent tetanus, as immunity can decrease with age.
