The Prevention of Infections in Older Adults: Vaccination

Patrick P. Coll, MD; Victoria W. Costello, MD; George A. Kuchel, MD; Jenna Bartley, PhD; Janet E. McElhaney, MD


J Am Geriatr Soc. 2020;68(1):207-214. 

In This Article

Abstract and Introduction


All living beings are at risk for experiencing infections; humans are no exception. The prestige and credibility of modern medicine is built in large part on achievements in preventing and treating infectious diseases. For most of human history, there was little that could be done to prevent and treat infections. Millions of humans, of all ages, have died from infections; and in some parts of the world, infection-related deaths remain common. Advances in preventing and treating infectious diseases include improved sanitization, sterilization, pasteurization, immunization, and antibiotics. Vaccination has played a major role in the prevention of lethal diseases, such as smallpox, diphtheria, cholera, and influenza. Because of developing or waning immune function, the young and the old are at particularly high risk of experiencing infections. Influenza and pneumonia remain common causes of death in older adults. Influenza, in particular, has the potential to result in premature mortality for all age groups, including those who are older and particularly those who live in congregate settings. Vaccination is important in promoting healthy aging.


Much has been achieved to prevent and effectively treat infectious diseases.[1] It is better to prevent an infection than to have to treat one. Improved sanitation, sterilization, pasteurization, and vaccination all play important roles in preventing infections. Vaccination prepares the immune system to be aware of and/or react to the presence of an infective agent in such a way that the infection is prevented or limited in its extent. Despite these advances, infectious diseases remain a major worldwide cause of illness and death. Because of changes in the immune system with increasing age, older adults are more susceptible to infectious diseases. Because of changes in their immune system, older adults also have an altered immune response to vaccinations. Multiple variables need to be considered when deciding which vaccinations to administer to older adults. This review aims to provide practitioners with practical information to guide these decisions.