Frail elderly

Date Commenced:
2012
Expected Date of Completion:
2016
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Project Main Description

The very old have a higher incidence and greater severity of vaccine-preventable diseases, due to both immune senescence and multiple co-morbidities. The CI team has a track record of novel research in the frail elderly, which will be used to build on research capacity in these important but understudied areas. Continuing improvements in health care, nutrition and disease prevention have led to dramatic increases in the proportion of the population that is elderly, which are set to continue. This shift in population age structure is accompanied by an increase in the number of ‘frail elderly’ who require greater levels of acute and chronic health care. Despite this, older adults are systematically excluded from randomized controlled trials (RCTs) of new interventions, drugs, devices and health-risk behaviours. Usually this stems from complex comorbidities, and multiple concurrent medications, being common exclusion criteria in RCTs. In some trials, extreme age alone (for example, age >85 years or even >65 years) is an exclusion criterion in its own right. In particular, the frail elderly have been underserved despite their higher levels of morbidity, and  recognized differences in response to drugs and also vaccines. We build on our track record of clinical research in the prevention of influenza and pneumococcal disease in frail, hospitalised or institutionalised elderly. We also examine other under-studied VPDs in this group, such as pertussis and herpes zoster. 

Progress/Update

Stream News

Watch videos from Elderly vaccine workshop:

Max Walker's presentation video

Raina MacIntyre's presentation video

Panel presentations highlights video

Equity in Disease Prevention: vaccines in the elderly workshop

Washington Post and Conversation piece by Raina MacIntyre

View presentations and photos from the workshop 'Equity in disease prevention - vaccines for the elderly'

 

Workshops

The NHMRC Centre of Research Excellence - Immunisation in Under Studied and Special Risk Populationswith the Public Health Association of Australia held an international workshop on Vaccination in the Elderly, featuring cutting edge presentations on the latest issues in elderly immunization on Friday June 20th in Melbourne, heard the latest scientific developments and thought-provoking discussions in ageism in health care.

The workshop brought together national and international stakeholders in immunisation, ageing and health, primary care, health services providers for the elderly group, insurance, researchers, government and non government organisations, community representatives, federal and state government policy makers and advocacy groups.

Keynote Speaker Mr Max Walker AM, former Australian test cricketer and AFL player, spoke about the importance of healthy ageing in society Read more

Other keynote speakers included Professor David Goldblatt,Professor of Vaccinology and Immunology and Head of the Immunobiology Unit at the Institute of Child Health, University College London (UCL). He is a Consultant Paediatric Immunologist at the Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) where he is also Director of Clinical Research and Development and Director of the National Institute for Health Research GOSH/UCL Biomedical Research Centre. He is Director of the WHO Pneumococcal Reference Laboratory.

Featured Panel discussion: How good is good enough for the elderly? This session highlighted ethical issues, value judgement, ageism in healthcare and how this may impact adversely on older people.

See Washington Post and Conversation piece by Raina MacIntyre here

Open this link  to see workshop presentations and photos

The shifting global demography and ageing of populations worldwide brings new challenges for health care, and an imperative for healthy ageing and preventive health strategies for adults. Immunization is the low hanging fruit for healthy ageing, and yet under-utilized for various reasons, including waning immunity in the elderly, lack of RCT data in this age group, and lack of provider confidence in vaccines for the elderly. The elderly people have a higher incidence of infection and more severe and serious consequences of infection. Diseases such as influenza, pneumococcal disease and herpes zoster have long been recognized as causing a high burden in the elderly, but evidence is also emerging for other infections such as pertussis being a major cause of the morbidity in this age group. Now, there are several vaccines which can prevent major infectious diseases in the elderly. To improve uptake of these vaccines, elderly vaccination should be viewed through a different lens to pediatric vaccination, accepting that vaccines are less immunogenic in the elderly. The population health impact of vaccines in the elderly, despite immunosenescence and lower immunogenicity, is still likely to be high given the increased disease incidence. Vaccination is an important and readily available means of prevention in the elderly. Ageing is everyone’s business – we all grow old and have loved ones who are elderly.

Read the full background paper here: http://dx.doi.org/10.4236/

"The elderly should not be denied vaccination because of waning and weaker immunity – new study shows robust responses to pneumococcal vaccines in frail elderly with absent immunity at baseline." See paper published in PLOS One.
http://www.plosone.org/article/info%3Adoi/10.1371/journal.pone.0094578
 

Stream Related Links

Publications

Year Published: 2015

Barnes A, Heywood AE, Mahimbo A, Rahman B, Newall AT, Macintyre CR. Acute myocardial infarction and influenza: a meta-analysis of case–control studies. BMJ. Epub ahead of print. August 2015. [Full text]

Dyda A, MacIntyre CR, Banks E, Kaldor J, Newall AT, McIntyre P, Liu B. Medicare Benefits Schedule data to monitor adult influenza immunisation in Australian adults. Public Health Research and Practice. Accepted for publication. August 2015.

Dyda A, MacIntyre CR, McIntyre P, Newall AT, Banks E, Kaldor J, Liu B. Factors associated with influenza vaccination in middle and older aged Australian adults according to eligibility for the national vaccination program. Vaccine. 33(29): 3299 - 3305. May 2015. [Full text]

MacIntyre R, Stein A, Harrison C, Britt H, Mahimbo A, Cunningham A . Increasing Trends of Herpes Zoster in Australia. PLoS ONE. 10(4): e0125025. April 2015. [Full text]

Wood JG, Goeyvaerts N, MacIntyre CR, Menzies RI, McIntyre PB, Hens N. Estimating vaccine coverage from serial trivariate serologic data in the presence of waning immunity. Epidemiology. Published ahead of print. March 2015. [Full text]

Liu B, Heywood AE, Reekie J, Banks E, Kaldor JM, McINTYRE P, Newall AT, Macintyre CR. Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a prospective cohort study. Epidemiology and Infection. Epub ahead of print. January 2015. [Full text]

Rahman B, Heywood A, Moa A, MacIntyre CR. Influenza vaccination and cardiovascular risk in patients with recent TIA and stroke. Neurology. 84(1):105. January 2015.

Year Published: 2014

Ridda I, Heywood A, Hueston L, Dwyer D, MacIntyre CR. The burden of pertussis in patients with and without recurrent ischaemic vascular events. Infectious Disorders - Drug Targets. [Epub ahead of print]. October 2014. [Abstract]

Menzies RI, Jayasinghe SH, Krause VL, Chiu CK, McIntyre PB. Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older. The Medical Journal of Australia. 200 (2): 112-115. August 2014. [Full text]

C. Raina MacIntyre, Iman Ridda, Zhanhai Gao, Aye M. Moa mail, Peter B. McIntyre, John S. Sullivan, Thomas R. Jones, Andrew Hayen, Richard I. Lindley . A Randomized Clinical Trial of the Immunogenicity of 7-Valent Pneumococcal Conjugate Vaccine Compared to 23-Valent Polysaccharide Vaccine in Frail, Hospitalized Elderly. PLOS ONE. 24(2):310-314.. April 2014. [Full text]

Cunningham AL, Litt J and MacIntyre CR. Immunisation for herpes zoster: current status. The Medical Journal of Australia. 200(5):243-244. March 2014. [Full text]

Newall AT, Dehollain JP. The cost-effectiveness of influenza vaccination in elderly Australians: An exploratory analysis of the vaccine efficacy required. Vaccine. 32(12):1323-5. March 2014. [Full text]

MacIntyre, CR., Heywood, AE. The Bradford-Hill criteria and evidence of association between influenza vaccination and ischaemic heart disease. Heart. Online publication. January 2014. January 2014.

R. MacIntyre, A. Heywood, P. Koovor . Influenza virus vaccine reduces risk of ischemic events: time for a large-scale randomized trial?. Future Cardiology. 10(1) 35-37 . January 2014.

Year Published: 2013

MacIntyre CR. Elderly vaccination—The glass is half full. Heart . 5 (12A): 80-85 . December 2013. [Full text]

MacIntyre CR, Heywood AE, Kovoor P, Ridda I, Seale H, Tan T, Gao Z, Katelaris AL, Siu HWD, Lo V, Lindley R, Dwyer DE. Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study . Heart. Online publication. December 2013. [Full text]

Liyanage SS, Rahman B, Ridda I, Newall AT, Tabrizi SN, Garland SM, Segelov E, Seale H, Crowe PJ, Moa A, MacIntyre CR.The aetiological role of human papillomavirus in oesophageal squamous cell carcinoma: a meta-analysis. PLoS ONE. 8(7): e69238. July 2013. [Full text]

Year Published: 2012

Ridda I, Yin JK, King C, MacIntyre CR, McIntyre P. The importance of pertussis in older adults: a growing case for reviewing vaccination strategy in the elderly. Vaccine. 30(48):6745-6752. November 2012. [Full text]

Liu BC, McIntyre P, Kaldor JM, Quinn H, Ridda I, Banks E. Pertussis in older adults: prospective study of risk factors and morbidity. Clinical Infectious Diseases. 55(11):1450-1456. July 2012. [Full text]

MacIntyre CR, Ridda I, Seale H, Gao Z, Ratnamohan VM, Donovan L, Zeng F, Dwyer DE. Respiratory viruses transmission from children to adults within a household. Vaccine. 30(19):3009-3014. April 2012. [Full text]

Year Published: 2011

MacIntyre R, Torzillo P, McIntyre P, Richmond P, Andrews R, Goldblatt D,Grabenstein J,Ridda I, Menzies R, Macartney K. An update on adult vaccination against pneumococcal disease- Proceedings of a Public Forum. UNSWorks. Conference proceedings. August 2011. http://handle.unsw.edu.au/1959.4/52369

Project Status
Current