Frailty and Influenza Vaccination Among Older Adults
Funded Grant
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Respiratory infections and pneumonia account for approximately 5% of deaths in the United States since 1999 and are a major burden on older adults. Vaccination against influenza has been the cornerstone of mitigating this burden. Older adults are a particularly important target for vaccination, with specific CDC recommendations for vaccination against S. pneumoniae and for preferential use of enhanced influenza vaccines. However, older adults have wide variation in health and functional status, which may reflect underlying physiologic aging in particular and immunosenescence in particular. Measures of frailty are useful clinical tools for assessing physiologic aging in older adults, and evidence of differential influenza vaccine effectiveness by frailty is limited. Assessing whether frailty is associated with reduced effectiveness of influenza vaccination among older adults has important implications for vaccination strategies. Revealing the links among frailty, immunosenescence, and vaccine responses will improve approaches to developing vaccines for those at the greatest risk of adverse outcomes if infected. Aim 1 will assess whether frailty, assessed electronically by the VA Frailty Index (VA-FI), is an effect modifier of influenza vaccine effectiveness among community-dwelling Veterans. Aim 2 will assess whether frailty is associated with poor outcomes among vaccinated Veterans in Community Living Centers (CLCs) and whether influenza infection is a mediator of such an association. Aim 3 will develop a pilot cohort to study the links among frailty, markers of immunosenescence, and outcomes following vaccination, identifying the physiologic pathways that affect vaccine responses among older adults. The first two Aims will establish the role of frailty in vaccine-related outcomes among older Veterans to inform VA vaccination policies, while the third Aim will provide the basis for a fully-powered study to find the biology of immunosenesence that links frailty and vaccine outcomes in humans. In addition, the career development and mentoring programs outlined in this award will accelerate Dr. Seligman’s path toward becoming an independent investigator at the intersection of geriatric medicine and infectious diseases.
