Gosney M
Department of Geriatric Medicine, University of Liverpool, England.
J Adv Nurs. 2000 Oct;32(4):892-7. doi: 10.1046/j.1365-2648.2000.01602.x.
Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.
流感在社区和医院都是一个重大问题，处于特别风险中的老年人应被纳入疫苗接种计划。1998年8月，英格兰首席医疗官将当前的流感免疫政策扩大到包括所有75岁及以上的人。然而，在此日期之前，只有那些患有并存心脏或呼吸系统疾病、流感风险增加的患者才会被常规接种疫苗。为了确定这些患者是否已接种疫苗，我们在1月和2月的8周时间里，对所有入住老年护理病房的患者进行了询问。该研究还确定了可能影响患者参与这一免疫计划的因素。对649名患有急性内科疾病的老年护理病房患者询问了上一年度的流感疫苗接种情况。在这649名患者中，279名适合纳入研究。其中39%的人接种了流感疫苗。在考虑171名未接种疫苗的患者时，25%（44名患者）实际上已被提供疫苗但拒绝接种，其中46%的情况是由于先前的副作用或担心预期的副作用。在那些未接种疫苗的人中，四分之三的人认为流感疫苗无效。不幸的是，患有并存心脏、呼吸或内分泌疾病的患者接种疫苗的可能性并不比没有这些疾病的患者更高。许多因急性内科问题入院的老年患者没有接种流感疫苗，原因包括未被提供疫苗接种、认为流感疫苗无效以及担心可能的副作用。社区医生和护士在促进这类高危人群接种疫苗方面的作用是显而易见的，应纳入资源规划中。
