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

Outline

• The Philippine Aging Population

• Health Promotion and Disease Prevention

• Role of Vaccination in the Elderly

• Challenges Ahead

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

Achieving longer life vs. improving quality of life

Expansion of morbidity

hypothesis

Compression of

morbidity hypothesis

Increasing life

expectancylonger

life but with worsening

healthincreased

consumption of health

care services and

products

Increasing life

expectancychronic disease

occur only in the much later

yearshealthy life prolonged

at a greater rate than total

years of lifeincreased

fraction of life spent healthy

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

0

10

20

30

40

50

60

70

% w

ith

AD

L/IA

DL

dif

fic

ult

y

60-64 65-69 70-74 75-79 80+

Age

male

female

Cruz, G.T. 2007. Philippine Population Review, 6(1): 87-101.

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)

• 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.

Illness-Wellness Continuum

High-Level

WellnessAwareness Education Growth

Premature

Death Disability Symptoms Signs

TREATMENT PARADIGM

WELLNESS PARADIGM

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

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

Vaccination for the Elderly

Health Promotion

Disease Prevention

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

Flu Vaccination in Community Elderly

N Engl J Med 2007;357:1373-81.

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 or Pneumonia

11 24855 0.46 [0.29, 0.74]

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

Pneumococcal Vaccination in the Elderly

Clin Infect Dis. (2008) 47 (10):1328-1338.

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

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

Zoster Vaccination in the Elderly

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

TDaP Vaccination in the Elderly

Brazilian Journal of Medical and Biological Research, 39: 519-523.

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

Level Challenge Possible Solutions

Health Professionals and Institutions,including HMOs

Increasing awareness of benefits of vaccination

Regular informationcampaign

“Doctors themselves hate needles!”

Health professionals as role models for vaccine utilization

Inconsistencies in vaccinationschedules

Well-disseminated and accepted guideline

Standing orders and vaccination packages

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

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