The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review

Abstract

Background: Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others.

Aims: Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases.

Methods: We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not.

Results: Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions.

Discussion and conclusions: This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.

Keywords: Health determinants; Influenza vaccination; Older adults; Vaccination hesitancy; Vaccination uptake.

Fig. 1

Prisma 2009 flow diagram. The flowchart illustrates the search strategy applied to answer the research question outlined. In total 479 studies were identified during the systematic data search (468 in scientific literature, 11 additional publications by hands-on search). Following qualitative evaluation and screening full text, 44 studies fulfilled predefined inclusion criteria of the publication and were further analysed in the review process

Fig. 2

Ecosystem of factors affecting influenza vaccination behaviour. This shows the model of social health determinants adapted for the results obtained in this scope review on factors affecting vaccination uptake for seasonal influenza among citizens older than 65 years. The framework does not reflect numbers of publications found or numbers of participants included in the respective studies. It just gives an overall view on factors described for vaccination uptake and hesitancy currently described in the literature