Vaccination as a health prevention strategy for elderly

1. Vaccination:
Health Promotion and Disease
Prevention in the Elderly
MARC EVANS M. ABAT, MD, FPCP, FPCGM
Director, Center for Healthy Aging, The Medical City
Clinical Associate Professor, Section of Adult
Medicine, Philippine General Hospital

2. Outline
• The Philippine Aging Population
• Health Promotion and Disease
Prevention
• Role of Vaccination in the Elderly
• Challenges Ahead

3. http://www.census.gov.ph/data/sectordata/sr05151tx.html

4. Achieving longer life vs. improving quality of life
Expansion of morbidity
hypothesis
Compression of
morbidity hypothesis
Increasing life
expectancylonger
life but with worsening
healthincreased
consumption of health
care services and
products
Increasing life
expectancychronic disease
occur only in the much later
yearshealthy life prolonged
at a greater rate than total
years of lifeincreased
fraction of life spent healthy

5. ADL and IADL difficulties
• High level of disability, 28.2%
• Females and those in the advanced ages generally
showing some difficulty in ADLs and IADLs
70
60
50
40
30
20
10
0
% with ADL/IADL difficulty
60-64 65-69 70-74 75-79 80+
Age
male
female
Cruz, G.T. 2007. Philippine
Population Review, 6(1): 87-101.

6. Implications
• Macro level: increase in demand for health
services which at present, the government is
ill-equipped to handle
• Burden of care then falls on the family but this
is threatened due to changing family
structures (e.g. migration of female family
members for work)

7. • Role of healthy lifestyle in any future
interventions designed to increase active life
expectancy
• Incorporating elderly health policies to those
benefitting the younger sector
• Preventive rather than curative approach.

8. Illness-Wellness Continuum
High-Level
WELLNESS PARADIGM
Awareness Education Growth Wellness
Premature
Death Disability Symptoms Signs
TREATMENT PARADIGM

9. Health Promotion
• The process of enabling people to
– increase control over, and
– to improve their health
• 3 basic strategies
– Advocacy for health
– Enabling all people to achieve their full health
potential
– Mediating between the different interests in
society in the pursuit of health.
Ottawa Charter for Health Promotion. WHO, Geneva,1986 as mentioned in
http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf

10. Disease Prevention
• covers measures not only to
– prevent the occurrence of disease, such as risk factor
reduction,
– but also to arrest its progress
– and reduce its consequences once established
• considered to be action which usually
– emanates from the health sector
– dealing with individuals and populations identified as
exhibiting identifiable risk factors
– often associated with different risk behaviours.
http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf

11. Vaccination
for the
Elderly
Health
Promotion
Disease
Prevention

12. Commonly Recommended Vaccines
for the Elderly ≥ 65 years old
Vaccine Dose
Influenza 1 dose annually
Pneumococcal 1 dose
Zoster 1 dose
Tetanus. Diphteria Td booster q 10 years
MMWR. 57(53). January 9, 2009

13. Flu Vaccination in Community Elderly
N Engl J Med 2007;357:1373-81.

14. Vaccination for Influenza in Homes for
the Elderly
Outcome Studies Participants Risk Ratio
Influenza-like illness 25 9211 0.75 [0.65, 0.87]
Influenza 8 1941 0.65 [0.32, 1.29]
Pneumonia 16 7097 0.53 [0.42, 0.65]
Hospitalisation for flu
11 24855 0.46 [0.29, 0.74]
or Pneumonia
Deaths from flu or
pneumonia
27 32179 0.46 [0.33, 0.63]
All deaths 1 305 0.40 [0.21, 0.77]
Cochrane Database of Systematic Reviews
2006, Issue 3. Art. No.: CD004876

15. Pneumococcal Vaccination in the
Elderly
Clin Infect Dis. (2008) 47 (10):1328-1338.

16. Pneumococcal Vaccination in the
Nursing Home
End point Incidence (per 1000
person years)
% reduction
in incidence
(95% CI) P value
Vaccine
group
(n=502)
Placebo
group
(n=504)
Pneumococcal
pneumonia
12 32 63.8 (32.1
to 80.7)
0.0015
Non-pneumococcal
pneumonia
43 59 29.4 (−4.3
to 52.3)
0.0805
All cause
pneumonia
55 91 44.8 (22.4
to 60.8)
0.0006
BMJ 2010; 340:c1004

17. Zoster Vaccination in the Elderly
Tseng, H. F. et al. JAMA 2011;305:160-166

18. Tseng, H. F. et al. JAMA 2011;305:160-166

19. TDaP Vaccination in the Elderly
Brazilian Journal of Medical and Biological
Research, 39: 519-523.

20. Challenges Ahead
Level Challenge Possible Solutions
Individual Elderly Improving vaccine
awareness and
acceptability
Regular information
campaigns
Improving individual
utilization
Enforcement of
appropriate
discounts,
competitive pricing
Improving vaccine
access
Vaccination centers

21. Level Challenge Possible Solutions
Health Professionals
and Institutions,
including HMOs
Increasing
awareness of
benefits of
vaccination
Regular information
campaign
“Doctors themselves
hate needles!”
Health professionals
as role models for
vaccine utilization
Inconsistencies in
vaccination
schedules
Well-disseminated
and accepted
guideline
Standing orders and
vaccination
packages

22. Level Challenge Possible Solutions
Research and
Industry
Vaccines perceived
as having many
undesirable effects
Continuing vaccine
research
New vaccines
preparations and
delivery systems
Vaccines not as
effective in the
elderly
Affordability of
vaccines

23. Level Challenge Possible Solutions
Government and
Policy Makers
Lag in government
participation in
provision of
vaccination for the
elderly, including
funding challenges
More aggressive
legislation
Allocation of
obviously limited
resources to a
growing sector of
the population
Coordination with
all experts and
stakeholders:
highest risk vs.
highest benefits