Vaccination chez des patients ages admis en readaptation: opportunites manquees? [Vaccination in elderly patients in rehabilitation: a missed opportunity?]

BACKGROUND: Immunization against influenza is recommended for elderly persons in Switzerland, but no national guidelines are currently available regarding immunization of the elderly against pneumococcus and tetanus. In addition, almost no data are available regarding immunization rates of the elderly in the general population. In this study we explored the immunization status for influenza, tetanus and pneumococcus of a selected elderly population admitted to a Swiss rehabilitation facility. POPULATION AND METHODS: The study population (n = 145) were patients admitted to a rehab facility during 3 consecutive winter months. Data on demographics, immunization, previous functional status (BADL, IADL), cognitive (MMSE) and affective status (GDS) were collected upon admission. RESULTS: Subjects' mean age was 79.4 years, 32.4% were male, 42.8% had BADLs dependencies and 81.9% IADLs dependencies. Most patients had normal MMSE and GDS scores. Vaccination rates were 39.3% for influenza, 12.4% for tetanus and only 2.1% for pneumococcus. In univariate analyses, people immunized against influenza were older than those who were not (p = 0.01). This relationship remained in multivariate analyses, controlling for gender, functional, cognitive and affective status. Subjects aged 80 and over were 2.5 times (95% CI 1.2-5.5, p = 0.02) more likely to be immunized against influenza, but were less likely to be immunized against tetanus (OR 0.3, 95% CI 0.1-0.9, p = 0.04). Functional status was not significantly associated with any vaccination status. CONCLUSIONS: Immunization rate for influenza in this selected population is similar to those described in US surveys. The positive association between older age and flu vaccination is surprising and needs further investigation. These results also indicate a need to educate patients and physicians in order to increase vaccination use, especially against pneumococcus