The Value of Vaccination in Older Adults: The Why

Abstract The incidence of vaccine-preventable diseases remains high among older adults in the US, despite longstanding immunization recommendations, and is projected to increase as the population ages. The impact of US population aging on the burden of four vaccine-preventable diseases (influenza, pneumococcal disease, shingles, and pertussis) was modeled over a 30-year time horizon, with cumulative direct and indirect costs increasing from $378 billion over 10 years to $1.28 trillion over 30 years. Compared to current levels of vaccination coverage, increasing coverage was predicted to avert over 33 million cases of disease and greater than $96 billion in disease-associated costs, with a corresponding increase in vaccination costs of approximately $83 billion over the entire 30-year time period. Specific examples of cost-effectiveness analyses that assess the epidemiologic and economic impact of vaccination against shingles and pertussis in older adults will be discussed. Part of a symposium sponsored by the Health Behavior Change Interest Group.


VACCINATION TO PROMOTE HEALTHY AGING: THE FIVE WS Chair: Leonard Friedland Discussant: Leonard Friedland
This symposium addresses the role of vaccination to promote healthy aging and the process of developing and maintaining the functional ability that enables wellbeing in older age. Adults age 65 and over are at increased risk of certain infectious diseases due to immunosenescence. Therefore, immunization of older adults against targeted infectious diseases, including pertussis, shingles, influenza, and pneumococcal disease, can help to reduce morbidity and premature mortality. Vaccines in development to protect against additional infectious diseases causing significant morbidity and mortality in older adults, such as respiratory syncytial virus, can further promote healthy aging. The population of older adults in the US is projected to grow significantly over the next 30 years, with a corresponding increase in the incidence and economic costs of vaccine-preventable diseases. Immunization of older adults is a proven, cost-effective strategy that is critical for reducing the public health impact and societal costs in an aging US population. Implementation of evidence-based recommended vaccines for older adults presents challenges, including financial barriers, addressing disparities and inequities in health care delivery for older adults, and overcoming vaccine hesitancy. We plan to review these topics and present data we have generated to support the value of vaccination in adults age 65 and over. Health Behavior Change Interest Group Sponsored Symposium.

VACCINATION IN OLDER ADULTS: THE WHO AND WHAT
Leonard Friedland, GSK Vaccines, Philadelphia, Pennsylvania, United States Aging brings increased impact of infectious disease in terms of hospitalization, morbidity, and mortality. This increased susceptibility to infection results from immunosenescence, age-related changes in the immune system, anatomic and functional changes, and environmental exposure to infections. Adults age 65 and over are at increased risk of pertussis, shingles, influenza and pneumococcal disease, and evidencebased recommendations for vaccination are protect older adults against these diseases. Underlying medical conditions including end stage renal disease, chronic lung, heart and liver disease, diabetes and immunocompromised place adults age 65 and over at increased risk of infectious diseases, therefore evidence-based vaccine recommendations in older adults with additional risk factors are in place to protect against varicella, hepatitis A and B, meningococcal meningitidis and Haemophilus influenzae type b. Investigational vaccines are developed to protect against infectious diseases causing significant morbidity and mortality in older adults, for example, respiratory syncytial virus, to further promote healthy aging. Part of a symposium sponsored by the Health Behavior Change Interest Group.

VACCINATION IN OLDER ADULTS: THE WHEN AND WHERE Sara Poston, GSK Vaccines, Philadelphia, Pennsylvania, United States
Despite the well-understood benefits of vaccination in older adults, national rates still fall below public health targets, especially among certain racial and ethnic groups. Recent scholarship examining healthcare use patterns in adults revealed that health care providers miss several opportunities to provide vaccination during regular healthcare encounters, including Medicare annual wellness visits. Several barriers to older adult vaccination have been identified, including lack of patient and provider understanding of the importance of vaccination, financial barriers to vaccines covered under Medicare Part D, and patient hesitancy about the safety and effectiveness of vaccines. Strategies to address these barriers will be discussed, including the use of national quality measures to strengthen incentives for adult vaccination. Part of a symposium sponsored by the Health Behavior Change Interest Group.

THE VALUE OF VACCINATION IN OLDER ADULTS: THE WHY Philip Buck, GSK Vaccines, Philadelphia, Pennsylvania, United States
The incidence of vaccine-preventable diseases remains high among older adults in the US, despite longstanding immunization recommendations, and is projected to increase as the population ages. The impact of US population aging on the burden of four vaccine-preventable diseases (influenza, pneumococcal disease, shingles, and pertussis) was modeled over a 30-year time horizon, with cumulative direct and indirect costs increasing from $378 billion over 10 years to $1.28 trillion over 30 years. Compared to current levels of vaccination coverage, increasing coverage was predicted to avert over 33 million cases of disease and greater than $96 billion in disease-associated costs, with a corresponding increase in vaccination costs of approximately $83 billion over the entire 30-year time period. Specific examples of cost-effectiveness analyses that assess the epidemiologic and economic impact of vaccination against shingles and pertussis in older adults will be discussed. Part of a symposium sponsored by the Health Behavior Change Interest Group.

WHO WORLD REPORTS ON HEARING AND VISION: MEETING THE GROWING NEEDS OF OLDER ADULTS
Chair: Carrie Nieman Co-Chair: Bonnielin Swenor Discussant: Charlotte Yeh The World Health Organization's (WHO) World Report on Vision was released in October 2019 and the World Report on Hearing debuted at the World Health Assembly in May 2020. The Reports recognize the fundamental nature of sensory health in the health and well-being of individuals and societies and outline the significant and growing burden of hearing loss and vision impairment across the life course. Together the efforts call for more affordable, accessible, and integrated care to foster sensory health for all and represent a major opportunity to advance vision and hearing care as public health priorities nationally and internationally. With the largest burden of sensory impairment among older adults, this symposium will focus on applying the findings and recommendations of the Reports to gerontology. The first presentations will provide an overview of the World Reports on Vision and Hearing from members of the core working groups involved in the Reports and discuss them within the context of the WHO's Decade of Healthy Aging. The second set of presentations will feature the latest findings related to sensory health from the Global Burden of Disease Study. In moving toward action, task sharing is a critical theme that runs throughout the Reports and we will cover the application of task sharing to hearing care as an example of applying public health principles to advance sensory health. As we advocate for improving the lives of older adults, sensory health remains a significant component with great potential for progress and collaboration.

WHO WORLD REPORT ON HEARING: IMPLICATIONS FOR THE UNITED STATES AND THE WHO DECADE OF HEALTHY AGING Carrie Nieman, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
The past 5 years have seen incredible advances in approaching hearing loss as a major public health issue. National efforts include the 2015 President' Council of Advisors on Science and Technology and the National Academies of Science, Engineering, & Medicine's 2016 Commission on Hearing Health Care for Adults, which led to the 2017 OTC hearing aid legislation and the expected debut of OTC hearing aids in 2020-2021. The World Report on Hearing amplifies these efforts. This presentation will cover the role of the Report in the context of the rapidly evolving hearing care landscape in the US and how the Report's call for affordable, accessible hearing care fit within current national efforts focused on older adults. Finally, the WHO recognized 2020-2030 as the Decade of Healthy Aging. We will discuss how the World Report on Hearing integrates with broader efforts to support healthy aging locally and globally. Task sharing, through models such as community health workers (CHWs), is considered an efficacious and cost-effective approach to extending access, addressing disparities, and building capacity. Increasingly, task sharing is recognized as a promising approach within sensory health. This session will share results from an NIH-funded trial of a first-in-kind CHW-delivered intervention along the U.S.-Mexico border. Trained CHWs provided a 5-week group aural rehabilitation program that included education and counseling on age-related hearing loss. A total of 136 Spanish-speaking older adults with hearing loss were randomized. Those in the immediate treatment group reported significantly greater use of communication strategies postintervention, which was maintained over 1 year. Participants were more likely to report taking action on their hearing at 6 months (OR:1.56, p=0.001) and 1 year (OR:1.82, p=0.001). Building upon lessons learned, including postintervention focus groups, the presentation will share guiding principles on the application of task sharing to support sensory health.