Increasing Preventive Measures in Older Patients

Disease prevention continues to be the hallmark of good care for patients throughout their lives, not just those in their 20s, 30s, or 40s. Older adults may face a multitude of medical challenges, taking the focus away from preventive care, but it’s a physician’s job to maintain that focus for the patient’s benefit. One clear need that is not being met well is immunization against vaccine-preventable diseases like influenza and pneumococcal disease. While there has been a greater focus on influenza vaccination, there hasn’t been enough attention on the need for pneumococcal vaccination. A one-time pneumococcal inoculation can be administered at any time of the year and is recommended for every American aged 65 and older. Now is the Time Although vaccination is a relatively simple intervention, the pneumococcal immunization rate among patients aged 65 and older is suboptimal. Pneumococcal infections cause substantial morbidity and mortality. Non-invasive disease (eg, pneumonia) is dangerous, especially for older patients, but invasive disease (eg, bacteremia and meningitis) is even more problematic. The fatality rate for pneumococcal bacteremia remains 15% to 20%; for pneumococcal meningitis, it’s 16% to 37%. The rate of death is significantly higher among adults 65 and older than among younger adults. Antibiotic resistance among pneumococci further underscores the importance of prevention. The pneumococcal polysaccharide vaccine (PPSV23) is safe and effective, and a single dose can protect against approximately 75% of all invasive pneumococcal disease in adults; vaccine efficacy against non-invasive disease is not as well established. Vaccination is recommended by the CDC for all adults 65 and older, and many of these patients also have comorbidities that further increase risk,...