Vaccination as a health prevention strategy for elderly
-
Upload
marc-evans-abat -
Category
Health & Medicine
-
view
406 -
download
1
Transcript of Vaccination as a health prevention strategy for elderly
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