A shot prevents frailty: Reframe your message about adult vaccinations, experts say

The uptake of adult vaccinations could be improved if physicians, pharmacists and other healthcare providers told patients that vaccines prevent functional decline, experts said at the Canadian Immunization Conference.

“I think we need to do a better job at changing the message to things that resonate with people; that these will keep you in your home, that they can prevent diseases that can cause catastrophic changes in your lifestyle,” said Dr. Shelley Deeks, deputy chief medical officer of health for Nova Scotia chair, National Advisory Committee on Immunization (NACI).

Traditionally, the uptake of recommended vaccinations for adults is low, although the COVID-19 vaccines are an exception. It’s not just vaccines. Adults are also getting poor marks for other preventative health measures, such as colorectal or breast cancer screening, noted Dr. Melissa Andrew, professor of medicine in the division of geriatrics at Dalhousie University in Halifax and the first geriatrician member of NACI.

There are multiple causes for the low uptake in vaccines by adults. Unlike children, adults don’t have anchoring visits to the family physician or they might not have access to primary care. They also might not know or recall what vaccinations they need.

Physicians and pharmacists should consider talking about vaccines, and recommending the ones patient’s need, at every patient encounter, Dr. Deeks said. For example, many older adults make frequent visits to the pharmacy, which is an opportunity for pharmacists to discuss vaccines.  

“If we communicate in a way that resonates with them, we’d probably do a better job at increasing coverage,” she said.

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While patients who are frail tend to have the highest uptake of vaccines for adults, patients who are on the more functional side of the frailty scale can benefit a great deal from vaccines, Dr. Andrew said. Frailty can be considered as an accumulation of health deficits, and an infection can add to that accrual of health problems.

Infections are often thought of as short-term, but patients and healthcare professionals must consider the long-term impact of an infection in older adults. Of 100 older people who are hospitalized, 68% will leave hospital, but 20% will have a catastrophic functional decline, meaning a loss of one or two activities of daily living, Dr. Andrew said.

“We’d like to turn that around and avoid frailty, and vaccination is a tool for doing that,” she said.

While messages about vaccination are often about preventing mortality or hospitalization, patients may react more to a message along the lines of: “It won’t just keep you out of hospital, it will keep you walking.”

In younger adults, there are messages about missing time for work. In older adults, it could be time missed volunteering or caring for grandchildren.

“We as doctors or pharmacists can communicate these things,” Dr. Deeks said.

Dr. Andrews said that one problem with promoting vaccination in adults is that “Everybody sees it as someone else’s job.” She said that many of the Royal College of Physicians and Surgeons of Canada core competencies did not include recommending vaccination.

The Canadian Immunization Conference was held in Ottawa from April 25 to 27.

The Canadian Immunization Guide for adults is available from Immunize Canada.

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