Influenza vaccination in older people: a geriatrician’s perspective

Influenza poses a significant threat to older adults, exacerbated by age-related immune decline and the high prevalence of chronic conditions. Despite being the most effective preventive measure, influenza vaccination rates among this population remain alarmingly low, with Italy and Europe failing to meet the World Health Organization’s target of 75% coverage for individuals aged 65 and over. This review, informed by a geriatric conference in Enna, Sicily, examines the epidemiology of influenza in older populations, the impact of frailty on vaccination, and specific considerations for patients with dementia and diabetes. High-dose (HD) and adjuvanted inactived vaccines emerge as vital tools, offering enhanced immunogenicity and efficacy tailored to the unique needs of older adults. Economic analyses underscore the high direct and indirect costs of influenza in older populations, advocating vaccination as a cost-effective intervention. The authors call for increased geriatrician advocacy, education of healthcare professionals, and tailored public health strategies to improve vaccine uptake, especially among frail individuals and those with dementia or diabetes. By addressing these gaps, influenza vaccination can significantly mitigate the clinical, economic, and social burdens of the disease in older adults. The review highlights barriers to vaccination, including healthcare workers’ hesitancy, misinformation, and logistical challenges in geriatric care settings. Enhanced vaccination strategies, particularly the use of HD vaccines, are shown to reduce hospitalizations, mortality, and healthcare costs. Furthermore, the integration of vaccination into life-course immunization policies is essential for minimizing disease burden and promoting healthy aging.