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Health Care for the Elderly

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Pneumonia and influenza vaccination rates continue to be suboptimal among elderly inner city residents

Half of all pneumonia-related deaths occur among people 65 years of age and older, and elderly people are more likely than younger people to die from influenza. Despite this, a recent study of inner city neighborhood health centers in Pittsburgh found that only 60 percent of elderly blacks and 79 percent of elderly whites were vaccinated against influenza. Furthermore, only 59 percent of elderly blacks and 70 percent of elderly whites were vaccinated against pneumonia.

Blacks were less likely than whites to think that their doctors would want them to be vaccinated against influenza (83 vs. 93 percent), and they were more likely to say that pneumonia vaccination (which is only needed one time) was more trouble than it was worth (21 vs. 10 percent). However, there were few other significant differences between blacks and whites in health beliefs about vaccinations, according to the study. The study was supported by the Agency for Healthcare Research and Quality (HS09874 and HS10864).

Richard K. Zimmerman M.D., M.P.H., and his colleagues at the University of Pittsburgh surveyed 220 people aged 66 and older—most of whom were poor but insured women—who were randomly selected from Pittsburgh neighborhood health centers in 2000. They were asked about their vaccination status as well as their beliefs about the risks, benefits, and need for these vaccinations.

Almost all respondents were aware of recommendations for the elderly to receive the influenza vaccine, but about half said they knew little about the pneumonia shot. Immunization rates varied substantially by practice site. Nearly all those interviewed said it was easy to get to a place to be vaccinated, but only two-thirds knew that Medicare covered the cost of these vaccines. The most common reason for not being vaccinated was the belief that they were not likely to contract the disease. The researchers recommend that health centers offer walk-in influenza vaccine clinics in the fall and use standing orders to vaccinate any elderly men and women who have not been vaccinated against pneumonia.

See "Immunization rates and beliefs among elderly patients of inner city neighborhood health centers," by Dr. Zimmerman, Tammy A. Mieczkowski, Ph.D., and Stephen A. Wilson, M.D., in the April 2002 Health Promotion Practice 3(2), pp. 197-206.

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