Vaccinations and preventive screening services for older adults: opportunities and challenges in the USA

Abstract

Vaccinations and disease-screening services occupy an important position within the constellation of interventions designed to prevent, forestall or mitigate illness: they straddle the worlds of clinical medicine and public health. This paper focuses on a set of clinical preventive services that are recommended in the USA for adults aged 65 and older, based on their age and gender. These services include immunisations against influenza and pneumococcal disease, and screening for colorectal and breast cancers. We explore opportunities and challenges to enhance the delivery of these interventions, and describe some recently developed models for integrating prevention efforts based in clinician offices and in communities. We also report on a state-level surveillance measure that assesses whether older adults are 'up to date' on this subset of preventive services. To better protect the health of older Americans and change the projected trajectory of medical costs, expanded delivery of recommended vaccinations and disease screenings is likely to remain a focus for both US medicine and public health.

Cancer Prevention Among Adults Aged 45–64 Years

“…11 In contrast, using a set of select clinical preventive services recommended by age and gender, about 26% of adults aged 50–64 years in 2009 were up-to-date on select services compared to about 48% of older adults. 24,25 Additionally, a study by Lima et al 26 found that adults aged 52–62 years with functional limitations were cared for primarily by spouses, the majority remained in the workforce and typically provided fewer hours of care as compared to that received by older age groups. Moreover, those in midlife, particularly women, are also more likely to be responsible for caring for both dependent adult children as well as older family members, which has serious implications for prevention.…”

“…25 In line with Healthy People 2020 targets, 35 a number of indicators for monitoring the use of clinical preventive services among adults aged 50–64 years have been identified, including a set of screening services and risk factors related to cancer detection and prevention. 24 Cancer prevention guidelines often include the recommended clinical preventive services (including colorectal cancer screening, mammography, and Pap tests) and also promote a reduction in cancer risk factors such as physical inactivity, smoking, alcohol consumption, and obesity.…”

Herpes ZosterVaccine to the Homebound Elderly: Prevention, Protection, and Access to Care

“…2 To combat these high risks in the elderly, the 10-year goal of Healthy People 2020 is to increase adult-vaccination rates of persons 65 years and older by 10%. 7 Of those who develop Hz, 10%-25% will develop peripheral herpetic neuralgia (PHN); the occurrence of PHN is 3 times higher in people 65 years or older. 8 This condition is the most prevalent, painful, and long-lasting complication of Hz, consisting of severe neuropathic pain, with only palliative treatment available.…”

“…This project was also influenced by the Healthy People 2020 initiative that recognized low adult vaccination rates and set a goal to increase vaccinations in adults by 10%. 7 The live attenuated Hz vaccine can reduce the incidence of a shingles outbreak by 70% in ages 50 to 59, 64% in ages 60 to 69 and 38% in ages 70 years and older. 4 Additionally, the Hz vaccine reduces the occurrence of PHN by 66% in ages 60 years and older.…”

“…Additionally, Hz vaccination is one of the four Grade A adult vaccines recommended by the U.S. Preventive Services Task Force. 7 The clinic's EHR systems incorporated the IIS registry of California in July 2017, the second month of the project, which allowed previous and future vaccinations to be registered in the tracking system.…”