Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City

• Published in: Journal of community health Vol. 37; no. 1; pp. 10 - 14
• Main Authors: Banach, David B., Ornstein, Katherine, Factor, Stephanie H., Soriano, Theresa A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2012; Springer Nature B.V
• Subjects: Adult Care Services; Aged, 80 and over; Community and Environmental Psychology; Community health services; Cross-Sectional Studies; Data processing; Dementia; Dementia disorders; Demographics; Demography; Elderly; Ethics; Female; Females; Geriatrics; Health Promotion and Disease Prevention; Home Care Services; Home health care; Homebound; Homebound Persons - psychology; Homebound Persons - statistics & numerical data; Humans; Immunization; Influenza; Influenza Vaccines - administration & dosage; Influenza, Human - prevention & control; Male; Medical service; Medicine; Medicine & Public Health; Morbidity; Mortality; New York City; New York City, New York; New York, New York; Nursing; Nursing Homes; Old age; Older people; Original Paper; Patients; Physicians; Population; Primary care; Primary Health Care; Public health; Seasons; Treatment Refusal - statistics & numerical data; Urban Areas; Vaccination; Vaccination - statistics & numerical data; Vaccination and vaccines; Vaccines; New York City; Influenza vaccination; Homebound elderly
• ISSN: 0094-5145; 1573-3610
• DOI: 10.1007/s10900-011-9409-z

Seasonal influenza vaccination is recommended for all persons aged ≥50 years to reduce influenza related morbidity and mortality, but vaccination coverage among community-dwelling elderly remains low. Homebound elderly receiving home-based primary care (HBPC) have fewer barriers to vaccination than other community-dwelling elderly. The Mount Sinai Visiting Doctors (MSVD) program provides HBPC to homebound elderly in New York City. This study assessed seasonal influenza vaccination coverage within an urban HBPC program and identified factors associated with vaccine refusal. A cross-sectional analysis of data from the 2008–2009 influenza season was completed and influenza vaccination coverage was assessed. The association between social, demographic and health-related characteristics and vaccine refusal was evaluated using bivariate analysis and multivariable logistic regression. Of 689 people aged >65 eligible for influenza vaccination, 578 (84%) accepted and 111 (16%) refused vaccination. In multivariable analysis, vaccine refusal was positively associated with female gender (adjusted odds ratio [AOR] = 1.85, 95% confidence interval [CI] 1.02, 3.35), black race (AOR = 2.04, 95% CI 1.28, 3.25), and living alone (AOR = 1.71, 95% CI 1.10, 2.67), and negatively associated with dementia (AOR = 0.59, 95% CI 0.37, 0.91). Seasonal influenza vaccine coverage in the MSVD program was high compared to nursing home and community-dwelling elderly. Offering patients vaccination at home without additional expense will likely improve vaccine coverage among urban homebound elderly. Understanding why vaccine refusal rates are higher among females, black patients, and those living alone should guide interventions to increase vaccine acceptance among this population.