Barriers to vaccination among older adults: Demographic variation and links to vaccine acceptance

Background

Despite risks of vaccine-preventable infectious diseases, many older adults are under vaccinated. The present study investigates possible barriers to acceptance of vaccines recommended for older adults and considers demographic variation and links to acceptance for distinct vaccines.

Methods

A mailed survey was conducted with 901 older adults (aged 65+) across the state of North Dakota, oversampling for rural regions. The survey addressed demographic characteristics, barriers to vaccination (including needle phobia, cost, lacking doctor recommendation, transportation, and scheduling uncertainty), and vaccine acceptance (including provider guidance acceptance and uptake for influenza, shingles, pneumococcal, and COVID-19 vaccines).

Results

Cost (27.2 %) and needle phobia (24.1 %) were the most prevalent barriers. Rural, lower educated, non-white, and living alone older adults experienced increased risks of barriers such as cost, lacking a doctor recommendation, transportation, and uncertainty how to schedule. Cost was associated with shingles vaccine uptake, whereas lacking doctor recommendation was associated with uptake for all vaccines except shingles. Needle phobia was associated with uptake of all vaccines except COVID-19. Transportation barrier was only associated with pneumococcal vaccine uptake.

Conclusions

These findings highlight relatively low prevalence of barriers, yet variability by older adults’ demographic characteristics. Further, the influence of barriers on acceptance varied by vaccine type. By better understanding the nuanced role of barriers to older adults’ vaccination, strategies to increase vaccination rates can be developed.