Prevalence and predictors of influenza vaccination among frail, community-living elderly patients: an international observational study

Influenza vaccine coverage and factors associated with non-vaccination among caregiving and care-receiving adults in the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake.

OBJECTIVES

We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years.

METHODS

We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015-2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients.

RESULTS

Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white.

DISCUSSION

Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs.

CONCLUSION

The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.

Factors associated with influenza vaccination coverage and willingness in the elderly with chronic diseases in Shenzhen, China

Elderly individuals with chronic illnesses are more prone to get influenza. We aimed to investigate the factors associated with influenza coverage and willingness in chronic disease patients aged ≥60 years in Longhua district, Shenzhen City of southern China. Data collected in October 2020 were used in this work. The immunization status of older persons with chronic conditions and their willingness to receive the vaccine were assessed. Multivariable logistic regression was employed to determine the respective independent factors related to vaccination coverage and willingness for influenza. Only 4.8% of 5045 people were immunized against influenza, whereas 92.7% of the individuals agreed to receive the vaccine. Individuals between the ages of 70 and 79 (adjusted OR [aOR] 1.47, P = .012), those with higher education levels (aOR 1.53, P = .005 for high school; aOR 2.44, P < .001 for college or above), those who use of a family doctor (aOR 2.91, P < .001), those who frequently have physical examinations once a year (aOR 2.52, P < .001), and those who have never smoked (aOR 1.62, P = .018) were positively associated with the influenza vaccination. Meanwhile, older age was adversely linked with influenza vaccination willingness (aOR 0.68 for 70-79 years, P = .003; aOR 0.55 for≥80 years, P = .025) in contrast to those aged 60-69. High willingness to get vaccinated was more frequent in people with a high school diploma (aOR 1.33, P = .037). In this work, we observed that the coverage is poor but the immunization desire is high regarding influenza vaccination. Interestingly, older age was associated with higher coverage and lower willingness. These suggest that raising immunization rates among older people with chronic conditions and strengthening health education for caregivers should be the primary concerns.

Association of Influenza Vaccination With SARS-CoV-2 Infection and Associated Hospitalization and Mortality Among Patients Aged 66 Years or Older

Importance

Vaccine effectiveness studies have rarely implemented strategies to reduce the healthy vaccinee bias arising from differences in health care-seeking behavior between vaccinated and unvaccinated individuals. Although previous observational studies suggest that influenza vaccination is associated with a reduced risk of SARS-CoV-2-associated outcomes, the healthy vaccinee bias may have led to overestimating the vaccination effect.

Objective

To estimate the association between influenza vaccination and SARS-CoV-2-associated outcomes.

Design, Setting, and Participants

This cohort study was conducted over 2 consecutive influenza vaccination campaigns (2019-2020 and 2020-2021), owing to the substantial COVID-19 burden and the greater validity of influenza vaccination data in the studied age group. The study population included community-dwelling adults aged 66 years or older in Ontario, Canada.

Exposure

Influenza vaccination for a given season.

Main Outcomes and Measures

The outcomes of interest included SARS-CoV-2 infection, SARS-CoV-2-associated hospitalization, SARS-CoV-2-associated death, and a composite of SARS-CoV-2-associated hospitalization or death. Cox proportional hazards models were used to measure the association between influenza vaccination and SARS-CoV-2-associated outcomes, censoring individuals who moved into long-term care, received COVID-19 vaccines, or died before the observation period end date. Primary care periodic health examinations (PHEs) were explored as a negative tracer exposure (ie, no association expected with SARS-CoV-2 outcomes) and as an effect modifier of the association between influenza vaccination and SARS-CoV-2 outcomes.

Results

Of 2 922 449 individuals aged 66 years or older (54.2% female) living in Ontario, 2 279 805 were included in the study. Among these, 1 234 647 (54.2%) were female and 1 045 158 (45.8%) were male; their mean (SD) age was 75.08 (7.21) years. Those who had received influenza vaccination exhibited a lower incidence of SARS-CoV-2 infection than unvaccinated individuals for the 2019-2020 cohort (adjusted hazards ratio [aHR], 0.78; 95% CI, 0.73-0.84) and the 2020-2021 cohort (aHR, 0.76; 95% CI, 0.74-0.78). This association was also observed for SARS-CoV-2-associated hospitalization or death (2019-2020: aHR, 0.83; 95% CI, 0.74-0.92; 2020-2021: aHR, 0.66; 95% CI, 0.63-0.70). Similarly, undergoing a PHE was also associated with a lower incidence of SARS-CoV-2 infection (aHR, 0.85; 95% CI, 0.78-0.91) and SARS-CoV-2-associated hospitalization or death (aHR, 0.80; 95% CI, 0.70-0.90), and modified the association between influenza vaccination and SARS-CoV-2 infection for vaccinated individuals who underwent PHE (aHR, 0.62; 95% CI, 0.52-0.74) and for vaccinated individuals who did not undergo PHE (aHR, 0.81; 95% CI, 0.76-0.87), and also SARS-CoV-2-associated hospitalization or death in vaccinated individuals who underwent PHE (aHR, 0.66; 95% CI, 0.49-0.88) and vaccinated individuals who did not undergo PHE (aHR, 0.85, 95% CI, 0.76-0.95).

Conclusions and Relevance

The findings of this cohort study suggest that undergoing a PHE may at least partially modify the association between influenza vaccination and SARS-CoV-2-associated outcomes in individuals aged 66 years or older, providing evidence of the healthy vaccinee bias that may affect vaccine effectiveness studies.

Association Between Unmet Essential Social Needs and Influenza Vaccination in US Adults

BACKGROUND

Although social factors influence uptake of preventive services, the association between social needs and influenza vaccination has not been comprehensively evaluated for adults seeking primary care in the USA.

OBJECTIVE

To determine the association between unmet social needs and influenza vaccination.

DESIGN

Retrospective, cross-sectional, multivariable logistic regression.

PARTICIPANTS

Persons completing ambulatory visits in a primary care department at a midwestern, urban, multispecialty, academic medical center between July 2017 and July 2019 (N = 7955 individuals included).

MAIN MEASURES

Completion of influenza vaccination in the 2018-2019 influenza season (primary outcome) or any year (secondary outcome) against 11 essential social needs (childcare, companionship, food security, health literacy, home safety, neighborhood safety, housing, health care provider costs, prescription costs, transportation, and utilities). Demographics, diabetic status, COPD, smoking status, office visit frequency, and hierarchical condition category risk scores were included as covariates.

KEY RESULTS

Individuals with transportation vulnerability were less likely to be vaccinated against influenza (current-year aOR 0.65, 95% CI: 0.53-0.78, p < 0.001; any-year aOR 0.58, 95% CI: 0.47-0.71, p < 0.001). Poor health literacy promoted any-year, but not current-year, influenza vaccination (any-year aOR 1.30, 95% CI: 1.01-1.69, p = 0.043). Older age, female sex, diabetes, more comorbidities, and more frequent primary care visits were associated with greater influenza vaccination. Persons with Black or other/multiple race and current smokers were less frequently vaccinated.

CONCLUSIONS

Transportation vulnerability, health literacy, smoking, age, sex, race, comorbidity, and office visit frequency are associated with influenza vaccination. Primary care-led interventions should consider these factors when designing outreach interventions.

TRIAL REGISTRATION

Not applicable.

Fostering healthy aging: The interdependency of infections, immunity and frailty

Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.

Older adults' vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults' hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.

The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020

In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.

Impacts of free vaccination policy and associated factors on influenza vaccination behavior of the elderly in China: A quasi-experimental study

BACKGROUND

Chinese elders are under high threats of seasonal influenza, while showing low influenza vaccination coverage comparing with other countries. The study explored the impacts of free vaccination policy and associated factors on influenza vaccination behavior of the elderly in Zhejiang Province, China, offering a guidance of interventions for protecting elders from seasonal influenza.

METHODS

1210 elders ≥60 years were conveniently recruited between July and September of 2019. 607 of them were sampled from 6 counties with free vaccination policy, while the other 603 elderly people were sampled from another 6 comparable counties without the policy. A self-reported questionnaire, involving socio-democratic information, physical status and behavior, influenza knowledge, vaccination awareness, relatives of healthcare workers, and vaccination behavior, was completed by elders under supports of research assistants. Chi-square tests and logistic regression analyses were performed to explore the impacts of research factors.

RESULTS

A total of 464 (38.3%, 95%CI: 36.9-39.7%) elders claimed that they got vaccinated, and the vaccination coverages of elders in the counties with and without free vaccination policy were 68.4% (95%CI: 64.7-72.1%) and 8.1% (95%CI: 5.9-10.3%), respectively. Protective and risk factors of vaccination behavior were identified, including free vaccination policy (OR_step = 27.29, 95%CI: 18.69-39.82), positive vaccination awareness (OR_step = 7.93, 95%CI: 5.50-11.43), catching cold frequently (OR_step = 2.00, 95%CI: 1.32-3.05), and having relatives of healthcare workers (OR_step = 0.56, 95%CI: 0.34-0.93). Age, education level, monthly income, family structure, physical status, and influenza knowledge were significantly associated with vaccination behavior. Having relatives of healthcare workers may indirectly affect vaccination behavior through vaccination awareness.

CONCLUSIONS

Free vaccination policy plays the most fundamental role of improving vaccination coverage among studied factors. To protect elders from seasonal influenza, effective measurements, such as issuing free vaccination policy, enriching influenza knowledge, and guiding positive vaccination awareness for both elders and healthcare professionals are recommended to be included into influenza immunization strategies.

Impact of Influenza Vaccination on Mortality in the Oldest Old: A Propensity Score-Matched Cohort Study

Influenza remains a major cause of illness and death in geriatric populations. While the influenza vaccine has successfully reduced morbidity and mortality, its effectiveness is suspected to decrease with age. The aim of this study was to assess the impact of influenza vaccination on all-cause mortality in very old ambulatory subjects. We conducted a prospective cohort study from 1 July 2016 to 31 June 2017 in a large unselected ambulatory population aged over 80 years. We compared all-cause mortality in vaccinated versus unvaccinated subjects after propensity-score matching, to control for age, sex and comorbidities. Among the 9149 patients included, with mean age 86 years, 4380 (47.9%) were vaccinated against influenza. In total, 5253 (57.4%) had at least one chronic disease. The most commonly vaccinated patients were those with chronic respiratory failure (76.3%) and the least commonly vaccinated were those suffering from Parkinson’s disease (28.5%). Overall, 2084 patients (22.8%) died during the study. After propensity score matching, the mortality was evaluated at 20.9% in the vaccinated group and 23.9% in the unvaccinated group (OR = 0.84 [0.75–0.93], p = 0.001). This decrease in mortality in the vaccinated group persisted whatever the age and Charlson Comorbidity index. In conclusion, nearly a half of this ambulatory elderly population received Influenza vaccine. After adjustment on comorbidities, influenza vaccination was associated with a significant decrease in all-cause mortality, even in the eldest multimorbid population. Improving immunization coverage in this frail older population is urgently needed.

Seasonal influenza vaccination in older people: A systematic review and meta-analysis of the determining factors

Background/Objectives

Despite influenza vaccination programs in various jurisdictions, seasonal influenza vaccine (SIV) uptake remains suboptimal among older people (≥65years old), an important subpopulation for influenza vaccination. We sought to summarize determinants of SIV uptake (any vaccine receipt) and vaccination adherence (receipt of vaccine in two or more seasons in sequence) among older people.

Methods

We searched for population-based studies conducted in community-dwelling older people (irrespective of their health status) from 2000–2019. Two reviewers independently selected publications for inclusion. One reviewer extracted data from the included studies; a second checked the extracted data for errors. Disagreements were resolved by discussion and consensus, or a third reviewer. We were interested in the determinants of SIV uptake and vaccination adherence. Where appropriate, we pooled adjusted results using the inverse variance, random-effects method and reported the odds ratios (OR) and their 95% confidence intervals (CI).

Results

Out of 11,570 citations screened, we included 34 cross-sectional studies. The following were associated with increased SIV uptake: being older (OR 1.52, 95%CI 1.38–1.67 [21 studies]), white (1.30, 1.14–1.49 [10 studies]), married (1.23, 1.17–1.28 [9 studies]), non-smoker (1.28, 1.11–1.47 [7 studies]), of a higher social class (1.20, 1.06–1.36 [2 studies]), having a higher education (1.12, 1.04–1.21 [14 studies]), having a higher household income (1.11, 1.05–1.18 [8 studies]), having a chronic illness (1.53, 1.44–1.63 [16 studies]), having poor self-assessed health (1.23, 1.02–1.40 [9 studies]), having a family doctor (2.94, 1.79–4.76 [2 studies]), and having health insurance (1.58, 1.13–2.21 [6 studies]). The influence of these factors varied across geographical regions. Being older (1.26, 1.11–1.44 [2 studies]) was also associated with increased vaccination adherence.

Conclusions

Several factors may determine SIV uptake and vaccination adherence among older people. More studies are needed to provide a stronger evidence base for planning more effective influenza vaccination programs.

Challenges in estimating influenza vaccine effectiveness

Introduction: Influenza vaccination is regarded as the most effective way to prevent influenza infection. Due to the rapid genetic changes that influenza viruses undergo, seasonal influenza vaccines must be reformulated and re-administered annually necessitating the evaluation of influenza vaccine effectiveness (VE) each year. The estimation of influenza VE presents numerous challenges. Areas Covered: This review aims to identify, discuss, and, where possible, offer suggestions for dealing with the following challenges in estimating influenza VE: different outcomes of interest against which VE is estimated, study designs used to assess VE, sources of bias and confounding, repeat vaccination, waning immunity, population level effects of vaccination, and VE in at-risk populations. Expert Opinion: The estimation of influenza VE has improved with surveillance networks, better understanding of sources of bias and confounding, and the implementation of advanced statistical methods. Future research should focus on better estimates of the indirect effects of vaccination, the biological effects of vaccination, and how vaccines interact with the immune system. Specifically, little is known about how influenza vaccination impacts an individual's infectiousness, how vaccines wane over time, and the impact of repeated vaccination.

Local deprivation status and seasonal influenza vaccination coverage in adults ≥ 65 years residing in the Foggia municipality, Italy, 2009-2016

Introduction

In Italy, vaccination against seasonal influenza has been recommended for the elderly since 1980, but coverage is still far below the WHO minimum target level of 75%. Effective interventions to improve influenza vaccination should take into account socioeconomic determinants of inequalities in vaccine uptake. This study aimed to assess differences in vaccination coverage, by socioeconomic status, among people ≥ 65 years of age residing in the Foggia municipality, Italy.

Methods

A Socio-Economic-Health Deprivation Index (SEHDI) was constructed by using a multivariate analysis model. The resident population, for census block, was classified in 5 deprivation groups. Differences in demographic and socioeconomic indicators, the standardized mortality ratios (SMRs), and the average vaccination coverage among deprivation groups were evaluated with the linear F-test. The association between census variables and influenza vaccination coverage, in each deprivation group, was assessed using the Pearson bivariate correlation.

Results

The SEHDI allowed to identify factors related to ageing, housing, household size and composition, and education. Forty percent of people residing in the Foggia municipality lived in conditions of socioeconomic and health deprivation. Belonging to families with 3 or 4 members was associated with increased coverage rates. In the most deprived group, vaccination uptake was positively associated with the dependency ratio.

Conclusions

The results of this study have shown that there is still large room for improving influenza vaccination coverage among subjects belonging to the most deprived areas. Surveillance of trends in influenza vaccine uptake by socioeconomic groups is a feasible contribution to implementing effective, tailored to the frail older persons, vaccine utilization programs.

Effect of dementia on receipt of influenza vaccine: a cohort study in French older adults using administrative data: 2007-2012

Despite guidelines stating the vaccine benefit in this population, older adults with dementia may be less likely to receive influenza vaccine than cognitively intact older adults. But no study has yet reported on vaccine uptake in patients newly diagnosed with dementia or whether years since dementia diagnosis influences vaccine uptake. We conducted a cohort study in the French Health Insurance database (Echantillon Généraliste de Bénéficiaires) which contains hospital data and claims for a 1/97th random sample of the French population. Diseased subjects were ≥65 years and had a new record of dementia diagnosis between September 1, 2007, and August 31, 2008. Vaccine receipt was measured via influenza vaccine dispensing in community pharmacies. We described influenza vaccination rates up to 2011-2012 and estimated adjusted relative risks (aRR) for vaccine receipt each year using multivariate modified Poisson models controlling for sociodemographics, comorbidities, and health resources use. Four hundred and seven subjects with dementia (mean age 81.8 years, 69.3% females) and 4862 subjects (mean age 75.2 years, 61.3% females) without dementia were included. In 2008-2009, influenza vaccination prevalence was 70.0% (95% CI = [65.3-74.4]) and 70.2% (95% CI = [68.9-71.4]) in subjects with and without dementia, respectively (aRR = 0.93; 95% CI = [0.87-1.00]). In 2009-2010, the aRR was of the same magnitude (aRR = 0.96, 95% CI = [0.90-1.03]), but in 2010-2011 and 2011-2012, the aRR was 1.02 (95% CI = [0.94-1.11]) and 1.05 (95% CI = [0.96-1.14]), respectively. Subjects with dementia had a slightly nonsignificant lower receipt of influenza vaccine in the year following dementia diagnosis than subjects without dementia. In subsequent years, divergent trends were observed in vaccine uptake according to dementia status.

Factors associated with influenza vaccine uptake in older adults living in the community in Singapore

In Singapore, influenza vaccination is recommended for persons at higher risk of complications of seasonal influenza, including those with chronic medical conditions and the elderly (individuals aged ⩾65 years). We investigated the factors associated with influenza vaccine uptake based on a nationally representative sample of community-dwelling adults aged >50 years. The data for this study were obtained from the National Health Surveillance Survey (NHSS) 2013. The association between influenza vaccine uptake and socio-demographic and health-related variables was analysed using univariable and multivariable logistic regression models. Of 3700 respondents aged ⩾50 years in the NHSS, 15·2% had received seasonal influenza vaccination in the past year. Older age, single marital status and economic inactivity were the socio-demographic variables independently associated with vaccine uptake. Health-related factors which were predictive of influenza vaccine uptake were sufficient total physical activity, better self-rated health, having at least one medical condition at risk of influenza complications and a regular family doctor/general practitioner. Influenza vaccine uptake in community-dwelling older adults was low. Our findings are of relevance in the formulation of public health policies and targeted health promotion strategies to increase vaccine uptake in this population group.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Factors associated with influenza vaccination coverage among the elderly in South Korea: the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV)

OBJECTIVE

The annual outbreak of influenza is one of the major causes of morbidity and mortality among the elderly population around the world. While there is an annual vaccine available to prevent or reduce the incidence of disease, not all older people in Korea choose to be vaccinated. There have been few previous studies to examine the factors influencing influenza vaccination in Korea. Thus, this study identifies nationwide factors that affect influenza vaccination rates in elderly Koreans.

METHODS

We obtained data from the Fourth Korean National Health and Nutrition Examination Survey 2007-2009 (KNHANES IV), a nationwide health survey in Korea. To assess influenza vaccination status, we analysed answers to a single question from the survey. From the respondents, we selected 3567 elderly population aged 65 years or older, to analyse the effects of variables including sociodemographic, health behavioural risk, health status and psychological factors on vaccination coverage. We identified factors that affect vaccination status using a multiple logistic regression analysis.

RESULTS

The rate of influenza vaccination in this elderly population was 75.8%. Overall, the most significant determinants for choosing influenza vaccination were a recent history of health screening (adjusted OR (aOR) 2.26, 95% CI 1.92 to 2.66) and smoking (aOR 0.78, 95% CI 0.62 to 0.98). Other contributing factors were age, household income, marital status, alcohol consumption, physical activity level, self-reported health status and a limitation in daily activities. In contrast, psychological factors, including self-perceived quality of life, stress and depressive mood, did not show close association with vaccination coverage.

CONCLUSIONS

To boost influenza vaccination rates in the elderly, an influenza campaign should focus on under-represented groups, especially smokers. Additionally, promoting routine health screening for the elderly may be an efficient way to help achieve higher vaccination rates. Our results highlight the need for a new strategy for the vaccination campaign.

Influenza vaccination uptake and its socioeconomic determinants in the older adult Iranian population: A national study

BACKGROUND

The relationship between socioeconomic status and influenza vaccine uptake has a different pattern in different societies. The objective of this study was to assess the socioeconomic factors influencing influenza vaccination uptake in the older adult Iranian population.

METHODS

In this cross-sectional study, 1,350 Iranian adults aged ≥60 years were selected using a multistage sampling method. Self-report questionnaires were administered to collect information on the status of influenza vaccine uptake within the last year.

RESULTS

Overall, 10.4% of the older adult Iranian population had received influenza vaccinations within the last year. Several determinants were associated with influenza vaccination uptake, such as current occupation, education level, ethnicity, source of income, financial support from relatives, satisfaction with income, type of health insurance, and having complementary health insurance for outpatient services. Other factors, such as age, sex, marital status, residential area, and having health insurance, had no influence on the probability of vaccine uptake. After adjusting for desired variables, we found that having an occupation (odds ratio [OR] = 2.08; 95% confidence interval [CI], 1.08-4.02) and having complementary health insurance for outpatient services (OR = 1.65; 95% CI, 1.06-2.56) remained associated with higher influenza vaccine uptake.

CONCLUSIONS

The influenza vaccination rate in older adult Iranians was found to be low. Occupation and having complementary health insurance were associated with influenza vaccination uptake among Iranian older adults. Considering the mentioned variables in future studies is advised.

Socioeconomic status and other related factors of seasonal influenza vaccination in the South Korean adult population based on a nationwide cross-sectional study

Purpose

We investigated the association between seasonal influenza vaccination in South Korea and socioeconomic status (SES) as well as other potential related factors.

Methods

The study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2011. Education level and household income were used as indicators for SES. Univariate and multiple logistic regression analyses were used to evaluate SES and other demographic variables as related factors for influenza vaccination, the primary outcome.

Results

Higher household income was positively associated with higher vaccine uptake in the younger (19–49 years) group [adjusted odds ratio (aOR) 1.55, 95% confidence interval (CI) 1.08–2.23], whereas the low-income and low-education group had increased vaccination coverage than the middle-income and middle-education group in the older (≥ 50 years) group (aOR 1.36, 95% CI 1.09–1.69). Current smokers tend to be unvaccinated in all age groups. Among individuals aged ≥ 50, older age, mild to moderate alcohol consumption, regular exercise, and having co-morbidities were positively associated with vaccination, while those who self-reported their health status as good were less likely to be vaccinated.

Conclusions

The relationship between SES and seasonal influenza vaccination coverage differed between the age groups throughout the adult South Korean population. Public health policies need to address these inequalities.

Mortalidade de idosos em município do Sudeste brasileiro de 2006 a 2011

O objetivo foi descrever a mortalidade entre idosos em Araraquara (SP), no período de 2006 a 2011. Estudo epidemiológico descritivo, tendo como fontes de dados o Sistema de Informações sobre Mortalidade e a Fundação Sistema Estadual de Análise de Dados. Foi calculada razão entre coeficientes de mortalidade por ponto (R) e por intervalo de 95% de confiança (IC95%). Observou-se mais de 60% dos idosos com nível baixo de escolaridade, sendo que 76% faleceram em hospitais. Entre 2006 e 2008, as diferenças foram estatisticamente significantes entre homens e mulheres, predominando as doenças circulatórias com R = 1,41 (IC95%:1,24-1,58), respiratórias com R = 1,49 (IC95%:1,22-1,76) e neoplasias com R = 1,79 (IC95%: 1,40-2,18). Entre 2009 e 2011, obteve-se, para as causas circulatórias R = 1,18 (IC95%:1,03-1,33), sendo significativas as diferenças para as respiratórias com R = 1,33 (IC95%:1,11-1,55) e câncer sendo R = 1,94 (IC95%:1,53-2,35). O diabetes mellitus e as causas externas apareceram, respectivamente, como quarta e quinta causas de mortes mais frequentes na população idosa. O padrão de mortalidade encontrado ressalta a importância de ações voltadas à redução das principais causas de morte, como o incremento da cobertura da vacina contra a influenza e o controle da hipertensão arterial e do diabetes mellitus.

Factors affecting repeated influenza vaccination among older people in Taiwan

OBJECTIVE

This study identifies factors that influence repeated influenza vaccination among people aged 65 years and older in Taiwan.

METHODS

Data of this retrospective cohort study were drawn from the 2005 National Health Interview Survey and the 2005-2007 National Health Insurance claims data; a sample of 1384 older people was analyzed. The pattern of repeated influenza vaccination was divided into 3 groups: unvaccinated all 3 years, vaccinated 1-2 times over 3 years, and vaccinated all 3 years. Multinomial logistic regression analyses were performed.

RESULTS

Only 20.6% of older people were vaccinated all 3 years. Those 70-74 years of age (odds ratio [OR]=1.81), living in rural areas (OR=2.47), having one (OR=2.07) or more (OR=2.41) chronic conditions, frequent outpatient visits (OR=1.48), and undergoing preventive health examinations (OR=2.22) were more likely to have repeated vaccinations. However, those with difficulties performing one or more activities of daily living (ADL difficulty) (OR=0.41) and seeking care from alternative medicine (OR=0.48) were less likely to undergo regular vaccinations.

CONCLUSION

The repeated influenza vaccination rates in our Taiwan sample were far from optimal. Factors identified in this analysis may help to improving influenza vaccination programs.

Vaccine history, gender and influenza vaccination in a household context

BACKGROUND

Few studies have investigated the effect of the history of vaccination on the current influenza vaccine uptake. The objective of this paper is to study the effects of vaccine history, for each sex separately, on the likelihood of vaccine uptake among single-head households and two-person households, controlling not only for the respondents' own prior vaccination history but also the history of vaccination among possible co-residents.

MATERIALS AND METHODS

We used logistic regression and data from a nationally representative telephone survey of the non-institutionalized Norwegian population aged ≥ 65 years to estimate our models (N=354). The survey was carried out in November 2008.

RESULTS

The lowest vaccine uptake was found among those who live alone with no prior history of vaccination and among those who live in two-person households where both members had no prior history of vaccination (10-22%). Those who live in two-person households where both members had previously been vaccinated had the highest vaccine uptake (86%). While a man who has previously been vaccinated has a higher likelihood of continued vaccination if his wife also has a prior history of vaccination, a woman with a prior history of vaccination is not dependent on her husband's prior practice with respect to the probability of continued vaccination. Of those who have no history of vaccination, more women than men are vaccinated for the first time when they have a spouse who has a history of vaccination.

CONCLUSION

Our study shows that the history of vaccination of a co-resident/spouse has an effect above and beyond the respondent's own vaccination history. The results indicate that there are gender differences in the willingness to encourage family members to be vaccinated or to embark upon a familial vaccination regime in order to protect the individual's own personal health and that of other family members from influenza. To the best of our knowledge such gender differences have never been shown before in research on influenza vaccine uptake. However, the finding is in accordance with a number of studies on the role of gender and the positive effect on health and mortality of social support and social control in marriage.

Influenza vaccine uptake among community-dwelling Italian elderly: results from a large cross-sectional study

Background

Flu vaccination significantly reduces the risk of serious complications like hospitalization and death among community-dwelling older people, therefore vaccination programmes targeting this population group represent a common policy in developed Countries. Among the determinants of vaccine uptake in older age, a growing literature suggests that social relations can play a major role.

Methods

Drawing on the socio-behavioral model of Andersen-Newman - which distinguishes predictors of health care use in predisposing characteristics, enabling resources and need factors - we analyzed through multilevel regressions the determinants of influenza immunization in a sample of 25,183 elderly reached by a nationally representative Italian survey.

Results

Being over 85-year old (OR = 1.99; 95% CI 1.77 - 2.21) and suffering from a severe chronic disease (OR = 2.06; 95% CI 1.90 - 2.24) are the strongest determinants of vaccine uptake. Being unmarried (OR = 0.81; 95% CI 0.74 - 0.87) and living in larger households (OR = 0.83; 95% CI 0.74 - 0.87) are risk factors for lower immunization rates. Conversely, relying on neighbors' support (OR = 1.09; 95% CI 1.02 - 1.16) or on privately paid home help (OR = 1.19; 95% CI 1.08 - 1.30) is associated with a higher likelihood of vaccine uptake.

Conclusions

Even after adjusting for socio-demographic characteristics and need factors, social support, measured as the availability of assistance from partners, neighbors and home helpers, significantly increases the odds of influenza vaccine use among older Italians.

Vacinação contra influenza em idosos: prevalência, fatores associados e motivos da não-adesão em Campinas, São Paulo, Brasil

O objetivo do estudo foi avaliar a prevalência de vacinação contra influenza em idosos e identificar os fatores associados e motivos da não-adesão à imunização. Estudo transversal de base populacional, com amostra estratificada por conglomerados e em dois estágios, realizado em Campinas, São Paulo, Brasil, em 2008 e 2009. Dos 1.517 idosos, 62,6% referiram vacinação no ano prévio. Atividade ocupacional, atividade física no lazer, diabetes, internação hospitalar e orientação de profissional de saúde estiveram associadas à vacina. Exceto para diabéticos, a vacinação em portadores de condições crônicas não atingiu níveis adequados. Os principais motivos para a não-adesão foram não considerar necessária e crença de que provoca reação. Condições socioeconômicas, estilo de vida e mobilidade física não restringiram o acesso, mas a cobertura esteve abaixo da meta estabelecida pelo Ministério da Saúde. Campanhas focadas nos idosos com 60 a 69 anos e nos portadores de doenças crônicas, bem como orientação do profissional de saúde, podem ampliar as coberturas em grupos que vêm apresentando baixa adesão às campanhas.

Campaign, counseling and compliance with influenza vaccine among older persons

OBJECTIVES

Population aging raises concerns regarding the increases in the rates of morbidity and mortality that result from influenza and its complications. Although vaccination is the most important tool for preventing influenza, vaccination program among high-risk groups has not reached its predetermined aims in several settings. This study aimed to evaluate the impacts of clinical and demographic factors on vaccine compliance among the elderly in a setting that includes a well-established annual national influenza vaccination campaign.

METHODS

This cross-sectional study included 134 elderly patients who were regularly followed in an academic medical institution and who were evaluated for their influenza vaccination uptake within the last five years; in addition, the demographic and clinical characteristics and the reasons for compliance or noncompliance with the vaccination program were investigated.

RESULTS

In total, 67.1% of the participants received the seasonal influenza vaccine in 2009. Within this vaccination-compliant group, the most common reason for vaccine uptake was the annual nationwide campaign (52.2%; 95% CI: 41.4-62.9%); compared to the noncompliant group, a higher percentage of compliant patients had been advised by their physician to take the vaccine (58.9% vs. 34.1%; p<0.01).

CONCLUSION

The education of patients and health care professionals along with the implementation of immunization campaigns should be evaluated and considered by health authorities as essential for increasing the success rate of influenza vaccination compliance among the elderly.

Gender influence in influenza vaccine uptake in Spain: time trends analysis (1995-2006)

This study aims to analyze gender differences in influenza vaccine coverage and predictors of vaccine uptake in Spain from year 1995 to 2006. We used data obtained from the Spanish National Health Surveys (NHSS) conducted in 1995, 1997, 2001, 2003 and 2006. Only subjects for whom the vaccine was recommended in Spain (age >or=65 years and <65 years with an associated chronic condition) during the entire study period were analyzed. Influenza vaccination status was self-reported. Independent variables included: year of survey, age, marital status, educational level, size of town, physician visits and chronic conditions. The study population included 26,653 (15,973 women and 10,680 men) individuals and 54.9% (CI 95% 54.3-55.5) were vaccinated. Vaccination coverage was higher among men than women in each and all of the NHSS analyzed. Positive predictors of vaccine uptake were the same among women and men including: higher age, being married, lower educational level, "Physician visits in last four weeks"; and the presence of associated chronic condition. Time trends 1995/1997-2006 showed that the coverage has improved for women (OR 1.12 CI 95% 1.09-1.16) and men (OR 1.11 CI 95% 1.06-1.15). Over the whole study period men had 12% greater probability of having received the vaccine. We conclude that in Spain there are significant gender differences in influenza vaccine uptake with lower coverage among women. These differences have remained throughout all years studied. We suggest that possible explanations for the lower uptake among women could include less social support, differences in the health status and provider bias.

Prevalence and Correlates of Influenza Vaccination among Kidney Transplant Patients

Context

Immunosuppressive regimens increase kidney transplant patients' risk of contracting life-threatening influenza. However, little information exists about the prevalence and correlates of influenza vaccinations in this population.

Objective

To determine the prevalence and explore correlates of influenza vaccination in kidney transplant recipients.

Design, Sample, and Setting

This cross-sectional study used data from the Supporting Medication Adherence in Renal Transplantation study. The convenience sample consisted of 356 adult kidney transplant recipients (58.1% male; mean age, 52.9 [SD 13.53] years) recruited from 2 Swiss transplant outpatient clinics. Influenza vaccination status was assessed by self-report (yes/no).

Main Outcome Measure

Known correlates of vaccination in chronically ill patients (older age, cohabitation, higher education, higher socioeconomic status, financial stability, more comorbid diseases, nonsmoking status, and clinical site where care is received) were entered into a multiple logistic regression model.

Results

Of the 356 patients, only 83 (23.3%) reported having been vaccinated against influenza in the previous year. Positive vaccination status was significantly related to older age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06).

Conclusion

Despite national and international guidelines recommending influenza vaccination in kidney transplant recipients, the prevalence of influenza vaccination in this sample was low. This study's results suggest that transplant centers need to implement policies to maximize influenza vaccination of their patients.

Influenza vaccination uptake and socioeconomic determinants in 11 European countries

BACKGROUND

The objective of this study was to assess the predictive effects of socioeconomic factors to explain influenza vaccination coverage rates in 11 European countries.

METHODS

Data from national household surveys collected over up to seven consecutive seasons between 2001/2002 and 2007/2008 were analyzed to assess the associations of socioeconomic factors with immunization against influenza.

RESULTS

In total, data from 92,101 household contacts representative for the national non-institutionalized population aged above 14 years were analyzed. Influenza vaccination coverage rates in Europe remain suboptimal with little or no progress in the last years. The results of this study indicate that gender, household income, size of household, educational level and population size of living residence may significantly contribute to explain chances of getting immunized against influenza apart from the known risk factors age and chronic illness. The effect of these socioeconomic factors was differently expressed among the countries and could not be explained solely on basis of economic characteristics of these countries.

CONCLUSIONS

Future measures should address inequalities to achieve the WHO target by 2010 with an influenza vaccination rate of 75% in the elderly. National vaccination campaigns may need to take socioeconomic segments of the population here identified as less likely of getting the influenza vaccine into account.

Shaping home care in Europe: the contribution of the Aged in Home Care project

OBJECTIVES

During the 1990s, use of home care sector has increased substantially in Europe. However, research on home care continues to be underreported. This article summarizes the findings from the "Aged in Home Care" (ADHOC) study - carried out from 2001 to 2004 in Europe - and women's situation in European Home Care.

METHODS

The review is based on 4 book chapters as well as on 23 articles listed in PubMed and published from August 2004 to October 2008. ADHOC used a standardized data set collected with the Resident Assessment Instrument for Home Care (RAI-HC 2.0); this instrument was used to assess 4010 home care clients at 11 European sites. The included articles analyzed the sociodemographic and clinical characteristics, basic physical needs, provision of selected preventive measures, and medication data from the ADHOC sample. In addition home service provision, quality indicators, and selected outcomes of home care intervention during the course of 1 year were assessed.

RESULTS

The mean subject age was 82.3 years; women were on average 2 years older than men and more frequently lived alone, 74% were women. Women suffered more frequently from pain, depression, and extreme obesity. There were marked regional differences in both the functional status of the clients and the characteristics and use of home care services.

CONCLUSIONS

The implementation of a common assessment instrument for HC clients may help contribute the necessary wealth of data for (re)shaping home care in Europe. Policy makers and service providers may learn about best practices in the European context.

Prevalence and correlates of influenza vaccination among non-institutionalized elderly people: an exploratory cross-sectional survey

Background

Worldwide pandemics of influenza virus caused extensive morbidity and mortality around the world and influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A large proportion of the Hong Kong elderly population has not undergone influenza vaccination. An exploration of the correlates will provide significant information to help identify ways of improving vaccination uptake among Chinese elderly people.

Objectives

To explore the prevalence and correlates of influenza vaccination Hong Kong Chinese elderly people aged 65 or above. To investigate any differences in attitudes toward influenza vaccination among Hong Kong elderly people with different levels of cognitive and physical functioning.

Design

An exploratory cross-sectional survey with two objective assessments was employed. Settings: Fifteen elderly centers in Hong Kong Special Administrative Region. Participants: A total of 816 Hong Kong Chinese elderly participants were recruited.

Methods

Face-to-face interviews were adopted to explore the demographic characteristics, perceptions, health status, knowledge, and resources of, and the influence of disease outbreaks on, influenza vaccination. Two objective validated instruments, the Chinese Mini-Mental State Examination (CMMSE) and the Barthel Index-Modified Chinese Version (MCBI) were used to assess the cognitive status and physical functioning of the participants.

Results

Approximately two in three individuals (62.4%) had undergone influenza vaccination. Lower cognitive and physical functioning scores were found among the non-vaccinated participants. Multivariate logistic regression analyzes revealed the significant correlates associated with influenza vaccination to be consideration of vaccination in the subsequent years (aOR = 7.877; p < 0.001); consideration of vaccination if all people aged 65 or above were eligible to receive free vaccination (aOR = 3.024; p = 0.002); the belief that there is a need to receive influenza vaccination following the Severe Acute Respiratory Syndrome (SARS) and avian influenza (aOR = 2.413; p = 0.001); receiving advice from nursing staff of elderly centers (aOR = 7.161; p < 0.001); the medical staff of elderly centers (aOR = 3.771; p < 0.001) or family members or friends (aOR = 3.023; p = 0.001).

Conclusions

The prevalence of elderly Chinese people undergoing influenza vaccination remains suboptimal. The government can promote vaccination by educating the public about the advantages, by publicizing locations where vaccinations are available, and having nursing, other medical staff, family and friends encourage elderly people to be vaccinated. A high vaccination coverage rate must be ensured to achieve international goals.

What factors affect influenza vaccine uptake among community-dwelling older Chinese people in Hong Kong general outpatient clinics?

AIM

This study aimed to identify the influenza vaccination rate among community-dwelling older Chinese people in Hong Kong general outpatient clinics and to identify the factors affecting their vaccine uptake.

BACKGROUND

Community-dwelling older Chinese people in Hong Kong underuse influenza vaccination. The first step to increase their vaccination rates is to understand the factors affecting their influenza vaccine uptake.

DESIGN

This was a retrospective and descriptive study.

METHODS

The sample comprised 197 subjects from five general outpatient clinics in the Kowloon East cluster of Hong Kong. A self-report questionnaire was used for data collection via individual face-to-face interviews.

RESULTS

Out of 197 subjects, 64.47% reported having received the vaccine within the previous 12 months. The regression model revealed that perceived benefits including 'vaccination prevents me from catching influenza (OR = 12.18, CI = 3.61-41.07, p < 0.001)', 'If I get vaccinated, I will decrease the frequency of medical consultation (OR = 8.12, CI = 2.70-24.38, p = 0.001)' and 'If I am vaccinated and still get flu, I will not be as sick with it (OR = 0.43, CI = 0.24-0.76, p = 0.004)', perceived barriers, which are 'the side-effects of influenza vaccination interfere with my usual activities (OR = 0.04, CI = 0.01-0.13, p < 0.001)', 'influenza vaccination is painful (OR = 2.73, CI = 1.55-4.81, p = 0.001)' and 'I am scared of needles (OR = 0.43, CI = 0.23-0.79, p = 0.007)' and recommendations from doctors (OR = 14.18, CR = 4.09-49.16, p < 0.001) and families (OR = 3.67, CR = 1.24-10.83, p = 0.019) interactively influenced the subjects' vaccine uptake.

CONCLUSION

Specific benefits and barriers affecting the influenza uptake of community-dwelling older Chinese people in general outpatient clinics have been identified. Specifically, recommendation from families plays a significant role in motivating the uptake of this Chinese ageing group.

RELEVANCE TO CLINICAL PRACTICE

We adopt strategies including personal invitation and reminders of influenza vaccination by doctors and educating doctors, older people and their families on influenza vaccination to increase the uptake of community-dwelling Chinese older people in general outpatient clinics.

New strategies are needed to improve the accuracy of influenza vaccine effectiveness estimates among seniors

OBJECTIVE

The magnitude of the benefit of influenza vaccine among elderly individuals has been recently debated. Existing vaccine effectiveness estimates derive primarily from observational studies, which may be biased. In this paper, we provide a methodological examination of the potential sources of bias in observational studies of influenza vaccine effectiveness in seniors and propose design and analysis strategies to reduce bias in future studies.

STUDY DESIGN AND SETTING

We draw parallels to bias documented in observational studies of therapies in other areas of medical research including pharmacoepidemiology, discuss reasons why existing adjustment methods in influenza studies may not adequately control for the bias, and evaluate statistical approaches that may yield more accurate estimation of influenza vaccine effectiveness.

RESULTS

There is strong evidence for the presence of bias in existing observational estimates of influenza vaccine effectiveness in the elderly and the failure of current adjustment methods to reduce bias.

CONCLUSION

Promising approaches for reducing bias include obtaining more accurate information on confounders, such as functional status, avoiding all-cause death in favor of outcomes, such as pneumonia or influenza-related pneumonia, and evaluating the extent to which bias is reduced by these and other methods using the 'control' period before influenza season.

Case management, preventive strategies, and caregiver attitudes among older adults in home care: results of the ADHOC study

BACKGROUND

Among older adults, integration of health services in a continuum of care with case management programs was shown to reduce progression of functional decline, hospitalization, and institutionalization. We hypothesized that such an approach may also result in a higher rate of use of preventive strategies and lower caregiver distress.

METHODS

Data were from the baseline assessment of the AgeD in HOme Care project, a study enrolling subjects aged 65 years or older receiving home care in Europe. Preventive strategies considered were: (1) blood pressure measured in the last 2 years; (2) influenza vaccination in the last 2 years; (3) medication reviewed in the last 180 days.

RESULTS

Mean age of participants was 82.3 years and 2971 (74%) were women; 1539 (38%) received home care program based on case management. Overall, 1350 (88%) of 1539 participants in the case manager group and 2046 (83%) of 2468 of those in the no case manager group had blood pressure measured in the last 2 years (P < .001). After adjusting for potential confounders, this result was still statistically significant (OR 1.31, 95% CI: 1.08-1.59). Similarly, more participants in the case manager groups received influenza vaccination (1083/1539 [70%] versus 1293/2468 [52%], P < .001) and had medication reviewed (312/1539 [20%] versus 356/2468 [15%], P < .001) compared with those in the no case manager group and these associations were confirmed after adjusting for confounders (OR: vaccination 2.08, 95% CI: 1.81-2.39; medication review 1.69, 95% CI 1.42-2.01). Furthermore, the caregivers of subjects in case manager group were less likely to be unable to continue in caring activities (49/1320 [4%] versus 134/2129 [6%], P = .01) and less dissatisfied (28/1320 [2%] versus 83/1129 [4%], P < .001) compared with those in the no case manager group.

CONCLUSIONS

Home care services based on case management approach result in a higher rate of use of preventive strategies and lower burden for caregivers.

Fatores associados à vacinação contra gripe em idosos na região metropolitana de Belo Horizonte

OBJETIVO: Estimar a cobertura e determinar os fatores associados à vacinação contra a gripe em idosos residentes na comunidade. MÉTODOS: O estudo foi conduzido na região metropolitana de Belo Horizonte em amostra probabilística de 1.786 residentes com>60 anos de idade. A variável dependente foi o relato de vacinação contra a gripe nos 12 meses precedentes. As variáveis independentes incluíram características sociodemográficas, estilos de vida relacionados à saúde; condições de saúde auto-referidas e uso de serviços de saúde. RESULTADOS: A cobertura da vacinação foi de 66,3%. As variáveis que apresentaram associações positivas e independentes com a vacinação foram faixa etária (70-79 e>80 anos; razões de prevalência ajustadas [RP] =1,20 e 1,18, respectivamente), exercícios físicos 6-7 dias por semana nos últimos 90 dias (RP=1,16); ter tido a pressão arterial aferida nos últimos dois anos (RP=2,37) e ter consultado um médico no último ano (1 e >2 consultas; RP=1,28 e 1,32, respectivamente). Associação negativa foi encontrada para ser solteiro (RP=0,82). CONCLUSÕES: Os resultados mostraram que a cobertura da vacinação na população estudada estava próxima à meta de 70% estabelecida pelo Ministério da Saúde. Os fatores associados à vacinação apresentaram estrutura multidimensional, que incluiu características demográficas, hábitos saudáveis e uso de serviços de saúde.

The impact of socioeconomic level on influenza vaccination among Italian adults and elderly: a cross-sectional study

OBJECTIVE

To assess the predictive factors of influenza vaccination among Italian adults, focusing on socioeconomic differences.

METHODS

A cross-sectional study was carried out using interview and self-reported data on 102,095 subjects aged 25-89 years from the national survey "health conditions and health care services use" conducted in Italy in 1999-2000. Analyses were stratified by age and multiple logistic regression models were used to estimate odds ratios (OR) of influenza vaccination.

RESULTS

Approximately one in six individuals (17.3%) received an influenza vaccine in the previous 12 months. Older age, poor health status and former smoking were all positively associated with influenza vaccination (P-value<0.05). Lower educated individuals and subjects with manual occupations were less likely to be vaccinated than those better off, with an OR ranging from 0.65 (95% CI 0.55, 0.77) to 0.82 (95% CI 0.71, 0.93). Among individuals aged 65-89 there was no apparent influence of both variables on the likelihood of receiving the influenza vaccine.

CONCLUSIONS

Socioeconomic inequalities in influenza vaccine uptake were present among the adults but not among the elderly. Because in Italy the National Health Service provides influenza vaccination to the elderly free of charge, it is possible that this policy attenuated the socioeconomic differential.

Influenza vaccine coverage rates and perceptions on vaccination in South Korea

Objective

This survey was performed to assess the level of influenza vaccine coverage, to understand the driving forces and barriers to vaccination and determine vaccination interventions for the following year in Korean population.

Methods

A national sample of 1720 community dwelling adults of age 18 and older were surveyed by individual visits during April 2005. Demographics, state of influenza vaccination, reasons for vaccination or non-vaccination and perceptions on vaccinations were asked by questionnaire.

Results

Influenza vaccination coverage in general population and high risk group was 34.3% and 61.3%, respectively. Predictors for vaccination were ≥65 of age, performance of regular exercise, vaccination in the previous season, experience of influenza-like illness, belief that vaccine can prevent common cold and opinion that vaccine must be taken annually. The most common reason for vaccination for both whole population and high risk groups was to prevent both influenza and common cold, while the most common reason for non-vaccination was the thought that he/she was healthy enough not to be in need for vaccination. Having more information on influenza and vaccination as well as doctor's recommendation for vaccination appeared to be the most important modus operandi to encourage influenza vaccination among non-vaccinees.

Conclusions

Doctor's recommendation was the most important factor in encouraging people to be vaccinated against influenza. Doctors should be geared up with precise information and actively encourage high risk population in order to increase vaccination coverage.

Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study

OBJECTIVES

The aims of the study were to describe the prevalence of physical activity in a sample of older adults in home care in Europe and to examine the relationship between physical activity and incident disability.

STUDY DESIGN AND SETTING

Study population consisted of a random sample of 2,005 subjects aged 65 or older admitted to home care programs in 11 European Home Health Agencies who participated in AgeD in HOme Care project. Participants who reported spending 2 or more hours of physical activities in last 3 days were defined physically active. Disability performing activities of daily living was defined as the need of assistance in one or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting.

RESULTS

More than 50% of participants were physically active. During a median follow-up of 12 months, 370 subjects (15%) became disabled. After adjusting for age, gender, and other possible confounding variables, active subjects were significantly less likely to become disabled compared to those reporting no or very low-intensity physical activity (OR, 0.67; 95% CI 0.53-0.84).

CONCLUSIONS

These findings support the possibility that physical activity has an independent effect on functional autonomy among frail and old people.

Influenza vaccination among persons with chronic respiratory diseases: coverage, related factors and time-trend, 1993-2001

BACKGROUND

Influenza vaccination has shown itself to be effective in reducing morbidity and mortality in patients with underlying chronic respiratory diseases. This study sought to: (1) estimate influenza vaccination coverage among asthma and chronic bronchitis sufferers; (2) ascertain which variables were associated with vaccination; and (3) analyse the time-trend in coverage between 1993 and 2001.

METHODS

This was a descriptive study covering the 2611 subjects included in the 1993, 1995, 1997 and 2001 Spanish National Health Surveys who reported suffering from asthma or chronic bronchitis. Vaccination coverage was calculated for each year and the influence of socio-demographic and health-related variables analysed. Using logistic regression, we assessed which of the variables had an independent effect on vaccination, and analysed the time-trend.

RESULTS

The proportions of vaccinated subjects in 1993, 1995-1997 and 2001 were 44.7%, 45.6% and 44.4%, respectively. Variables that increased the likelihood of having been vaccinated were: higher age, presence of another concomitant chronic disease, poor perception of health, non-smoker status, and being married. There was no significant variation in coverage over the study period.

CONCLUSION

Influenza vaccination coverage among Spanish asthma and/or chronic bronchitis sufferers is below desirable levels and showed no improvement over the period 1993-2001. Implementation of strategies to improve coverage is necessary.