The faculty and residents of the Preventive Medicine Program at University Hospitals Cleveland Medical Center and Case Western Reserve University have served on the COVID-19 pandemic Physician Response Team at the Cuyahoga County Board of Health, under the direction of Heidi Gullett, the Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine. We asked the team—consisting of Prakash Ganesh, Jill Miracle, Johnie Rose, Kurt Stange, Pauline Terebuh and Wail Yar—about vaccine hesitancy among older adults.
Research indicates that only 56% of adults ages 65 and older get all of the vaccines that their health care professionals recommend, including shingles and annual influenza shots. What are some reasons why older adults may be hesitant to get vaccines?
As human beings, we frequently tend to give more weight to avoiding immediate inconvenience or discomfort (getting a shot) over longer-term, more uncertain risks, like experiencing life-threatening influenza or COVID-19 disease. One big influence is the news that people watch and information that friends and family say or experience. The only member of our group eligible for the shingles vaccine (those 60 years of age or older) got it enthusiastically after seeing a relative struggle with painful shingles for years. For people who have never seen anyone with a severe case of influenza or COVID-19 infection, the benefit of vaccination feels more uncertain, whereas the concern about side-effects feels more real and immediate.
It is encouraging, however, that despite key concerns with the COVID-19 vaccine, a recent survey shows that three-fourths of people over 65 say they will definitely get the vaccine, while only about 6% say they wouldn’t get it.
Older adults who report that they are unlikely to get the COVID-19 vaccine cite concerns over side effects. What are the most common side effects or known risks for older adults who get the vaccine?
Interestingly, side effects are often milder for older people. The most common side effect is local pain at the injection site. Some people may experience other symptoms, including fatigue, headache, muscle or joint pain, chills, fever, swelling, and nausea. All these typically fade in a couple days.
Are there any special considerations for older adults with underlying health problems, such as a history of cancer, diabetes or heart failure?
The special consideration is to get the vaccine as soon as you have the chance! Having a history of these illnesses makes individuals more susceptible to severe COVID-19 illness if infected. Thus, it is even more important for these individuals to get the vaccine. The vaccines are very safe and effective. If you are concerned, you should discuss your particular situation with your primary health care professional.
Nearly 80% of older adults say that they most trust their physician or other health care professional for health information, including vaccines. What are the best questions older adults can ask their health care professional if they have concerns about the COVID-19 vaccine?
A good question to ask is “Given my medical history, are there any specific issues I should consider regarding the COVID-19 vaccine?” In their concern about large scale distribution of the vaccine, policymakers seem to have forgotten that most Americans have a primary care clinician, and most primary care practices routinely give vaccinations. Even if the vaccine is not yet available from their regular clinician, those health professionals will have information about the vaccine and where they can receive a vaccination.
What advice would you give to adult children who want to encourage an older parent to get the COVID-19 vaccine?
In this time of social isolation, a good place to start might be to re-establish your loving connection. Listen sympathetically to any concerns they may have, and try to get a sense of their convictions and motivations. If you feel they have been the victim of misinformation, see if you can get a sense of what sources they find credible and share information from those sources. Help them understand that getting the vaccine will make it safer to be with family (including grandchildren!), which may be more motivating for some than just protecting themselves. Strategize with them or offer to help with the logistics of getting the vaccine. Express your care for them, your intention of getting the vaccine as soon as you are able, and that getting more people vaccinated will let us all get back to our normal activities. Lastly, it is important to keep the conversation supportive and positive.