- Literacy barriers. Limited or marginal literacy, which especially affects older adults, may contribute to low rates of immunizations (Jacobson, 1999).
- Safety concerns. Studies found that older adults both fear adverse reactions and lack confidence in vaccine efficacy (Ives, 1994). According to the 1996 Medicare Current Beneficiary Survey, the top reasons for why older adults had not received the influenza vaccine were lack of knowledge that the vaccines were recommended and concerns about safety (Burns, 2005).
- Lack of provider recommendations. Health care providers do not persuade the elderly to be immunized (Ives, 1994). Failure of health care providers to recommend immunizations results in low immunization rates in this group (Ohmit, 1995).
- Cost. Cost of certain vaccines (e.g., influenza) may deter some older adults from getting the immunization (Ives, 1994).
- Lack of time during health care visits. Missed opportunities to immunize occur frequently. The most important reason is that the primary care health care provider has too little time and too many services to deliver (Szilagyi, 1996).
Strategies to address these considerations:
- Address literacy. Use low literacy materials to convey immunization messages to older adults (Jacobson, 1999). Health care workers need to be sensitive to the health literacy level of individuals when discussing immunizations and distributing written information (Niederhauser, 2005).
- Tailor individual education. While discussing immunizations with individuals, health care providers can address many of the common reasons given for not receiving the vaccine (Nichol, 2006). Other providers such as pharmacists and nurses can play an important role by educating individuals and offering and administering needed vaccines (e.g., influenza). Increasing or improving patient education can change the minds of older adults who refuse immunizations that have been recommended by the provider (Burns, 2005).
- Establish standing orders. Standing orders programs authorize nurses and pharmacists to administer immunizations according to an institution- or health care provider-approved protocol, without a health care provider's exam. These programs have documented improved immunization rates among adults. Standing orders programs can be used in inpatient and outpatient facilities, long-term-care facilities, managed-care organizations, assisted living facilities, correctional facilities, pharmacies, adult workplaces and home health care agencies to immunize patient, client, resident and employee populations (McKibben, 2000). The Advisory Committee on Immunization Practices (ACIP) recommends standing orders for influenza and pneumococcal immunizations as well as other vaccines when feasible (CDC, 1998).
- Utilize reminders and recalls. Health care providers can tailor their billing systems to function as reminder/recall systems for simple procedures, such as selecting all individuals over the age of 65 for reminders about influenza immunization. Many billing systems have recently incorporated separate modules that can track immunization statutes (Szilagyi, 2000).
- Utilize non-traditional settings. Alternative immunization sites have been used with success among older adults to increase immunization compliance by increasing access to health care. Pharmacies are becoming increasingly popular sites for adult immunization (Middleman, 2007).
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