Key TakeawaysThe Centers for Disease Control and Prevention (CDC) is recommending that people get vaccinated against COVID-19—especially older adults.Even after people get both doses of the COVID-19 vaccine, they must remain vigilant at protecting themselves from catching the virus and spreading it to others.Everyone needs to continue to maintain social distancing, wear face masks, and practice proper hand hygiene.Older adults, who are at an increased risk for severe illness or death if they get COVID-19, should stay in close contact with their doctors and tell them about any changes in their health. After they get the COVID-19 vaccine, they should also let their doctor know about any side effects they experience.

Key Takeaways

The Centers for Disease Control and Prevention (CDC) is recommending that people get vaccinated against COVID-19—especially older adults.Even after people get both doses of the COVID-19 vaccine, they must remain vigilant at protecting themselves from catching the virus and spreading it to others.Everyone needs to continue to maintain social distancing, wear face masks, and practice proper hand hygiene.Older adults, who are at an increased risk for severe illness or death if they get COVID-19, should stay in close contact with their doctors and tell them about any changes in their health. After they get the COVID-19 vaccine, they should also let their doctor know about any side effects they experience.

The Advisory Committee on Immunization Practices (ACIP), a panel of independent experts advising the Centers for Disease Control and Prevention (CDC), has recommended that people living in long-term care facilities, as well as those age 65 and older, be included in Phase 1 of the COVID-19 vaccination program.

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The ACIP met on Dec 1 ahead of the FDA’s decisions to grant an emergency use authorizations to theCOVID-19 vaccinesfromPfizer-BioNTechandModerna. The ACIP recommended that healthcare workers and those living in long-term care facilities be the first to receive the vaccine (Phase 1a).

The ACIP met again on December 20 and updated its recommendations to include Phase 1b and Phase 1c priority groups. At this meeting, the ACIP put adults ages 75 and older in Phase 1b and adults ages 65 to 74 in Phase 1c.

States, which are in charge ofdistributing shipments of the vaccine, are not required to follow the CDC’s recommendations, but many are including older adults and long-term care residents among the initial vaccine recipients.

On January 12, the Department of Health and Human Services announced at a press briefing that vaccination should begin for people 65 and older and those with underlying medical conditions that are considered high risk for COVID-19.President Joe Biden also announced plans to increase eligibility, including to those 65 and older.

Hashmi doesn’t think there should be any hesitation in proceeding to get vaccinated if it’s available to high-risk people and seniors, “unless they’re [presently] sick or if they’ve had COVID before.”

As of January 19, at least 28 states included adults 65 and older in their Phase 1a or Phase 1b priority groups. Among these states, 15 had started vaccination and registration for this age group.Supplies are still limited so there are often long waits to get an appointment.

COVID-19 and Older Adults

An At-Risk Population

According to the CDC, older adults are more likely than the general population to require care when they contract COVID-19. Compared to adults ages 18 to 29, adults who are between 65 to 74 years old are five times more likely to require hospitalization and 90 times more likely to die from COVID-19. Outcomes get worse for every subsequent age bracket.

According to the CDC, 65% of COVID-19 cases occurred in people under the age of 50. However, 95.4% of deaths occurred in people ages 50 and older.

One reason is that people of any age who havecomorbidities(or multiple chronic medical conditions) are more susceptible to COVID-19. Chronic health conditions tend to be more prevalent among older adults. Approximately 77% of older adults have at least two chronic diseases, such aschronic obstructive pulmonary disease (COPD),hypertension (high blood pressure),cardiovascular disease, ordiabetes.

Compounding the risk for COVID-19 for older adults is a weakenedimmune system. Hashmi says that the immune system generally weakens with age and adds that older adults do not have the same immune cells that can fight off and remember infections to provide future protection. Therefore, it’s important that older adults get a vaccine to help their bodies form a defense against COVID-19.

“You always need to be very, very cautious because they are more susceptible to COVID-19," Hashmi says, adding that the risks of having a weakened immune system and the greater likelihood of comorbidities “are unique to the senior patient population.”

COVID-19 and Pre-Existing Conditions

Prioritizing Long-Term Care Residents

On February 29, 2020, the CDC and the state of Washington reported the presumed first COVID-19 related hospitalizations: a resident and employee at a long-term care facility (LTCF). They also reported the first death—a man in his 50s.Since then, LTCF and prisons have continued to be COVID-19 hotspots.

In the United States, there are about 3.5 million people in LTCFs—an umbrella term forcongregate livingwhich includes skilled nursing facilities, assisted living, independent living, and continuing care retirement communities.

LTCFs are seeing approximately 5,000 deaths per week related to COVID-19 and more than 1,000 long-term care workers have died from the virus, saysMark Parkinson, the president and CEO of The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 long-term care facilities across the country.

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LTCFs are experiencing the worst outbreak of new cases since the spring, at which time they had to place restrictions on outside visitors and make drastic changes to contain and slow the spread of COVID-19.

“The risk is if one person gets COVID-19, and you are living in a community where there are a lot of other seniors who also have decreased immune systems, many comorbidities and are also older, the chances of very rapid spread in the community are very high,” Hashmi says. “You want those communities of seniors who are all at high risk to be prioritized ahead of the general population.”

Hashmi says that for the general population and those who are younger, their immune systems will be better prepared to fight the infection. “They’re still at risk,” says Hashmi, “But they are not as at risk as [those] in the older population.”

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The Effort to Inoculate

Hashmi expects that the process to inoculate older adults living in LTCFs will be fairly straightforward because it’s easier to get vaccines to people in a defined geographical setting.

However, Hashmi also thinks that it will be more difficult to prioritize older people who live in the general community and get them to a vaccine distribution center—especially if they are frail or do not have easy or reliable transportation.

Those distribution details will be worked out in the coming weeks, but Hashmi’s larger concern isconvincing older adults to get vaccinatedin the first place.

According to a Pew Research Center survey, in November 2020, an estimated 60% of Americans said they would “definitely” or “probably” get aCOVID-19 vaccineif it were available today.

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Why Older Adults Are Excluded From Trials

In a research letter published in September 2020 inJAMA Internal Medicine, the authors detailed their review of 847 COVID-19 treatment and vaccine trials to evaluate their risk for the exclusion of older adults—something the authors note there is a history of in clinical trials.

The review found that older adults are likely to be excluded from more than 50% of COVID-19 clinical trials and nearly 100% of vaccine trials.

“Such exclusion will limit the ability to evaluate the efficacy, dosage, and adverse effects of the intended treatments,” the authors wrote. “We acknowledge that some exclusions for severe or uncontrolled comorbidities will be essential to protect the health and safety of older adults. However, caution must be taken to avoid excluding otherwise eligible participants for reasons that are not well-justified.”

Hashmi says that the exclusion of older adults in drug development and research is not unusual—largely because of the same anxiety many people are feeling now about safety, adverse side effects, and efficacy.

Pfizerreported that its vaccine is 94% effective in people 65 and older.Modernahas reported that its vaccine is more than 95% effective, and a separate FDA analysis showed 86% efficacy in adults 65 and older.

From a research perspective, there are also ethical considerations when involving a population with potential memory concerns because they have to give their consent to participate.

Preserving Quality of Life

“What we are seeing both in the hospital as well as the community is the infection tends to last a lot longer in our older patients because they just don’t have the homeostenosis—the ability to fight back and recover from this virus sooner," Hashmi says. In these cases, the hospital stays are longer and the risk of being admitted to the intensive care unit or dying is much higher.

Hashmi says that if a vaccine can prevent people from getting COVID-19, it’s a huge boon for their quality of life—even if they’re inhospice. The virus causes symptoms such as diarrhea, fatigue, confusion, fever, and shortness of breath—which can make the last phase of life difficult and uncomfortable.

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Patients who are concerned about getting vaccinated whileon chemotherapy to treat canceror immunosuppressant medications, such as post-transplant, should talk to their healthcare providers. Patients should also ask their doctors about the optimal time to get theirfirst and second doses.

“When organizations like the ACIP and the FDA advocate for people to get the vaccine, they really mean it,” Hashmi says.

What This Means For YouOlder adults are at a higher risk of being hospitalized or dying from COVID-19. Therefore, the CDC is recommending that states prioritize vaccination for people age 65 and older, as well as those who live in a long-term care facility.

What This Means For You

Older adults are at a higher risk of being hospitalized or dying from COVID-19. Therefore, the CDC is recommending that states prioritize vaccination for people age 65 and older, as well as those who live in a long-term care facility.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

13 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Dooling K, Marin M, Wallace M, et al.The Advisory Committee on Immunization Practices’ updated interim recommendation for allocation of COVID-19 vaccine — United States, December 2020.MMWR Morb Mortal Wkly Rep2021;69:1657-1660. doi:10.15585/mmwr.mm695152e2

C-SPAN.New conference on COVID-19 vaccine distribution.

Kaiser Family Foundation.The COVID-19 priority line continues to change as states make further updates.

The Centers for Disease Control and Prevention.Older adults and COVID-19.

Centers for Disease Control and Prevention (CDC).CDC COVID data tracker.

National Council on Aging.Facts about healthy aging.

Centers for Disease Control and Prevention (CDC).CDC, Washington state report first COVID-19 Death.

Center for Infectious Disease and Research Policy.Studies spotlight high COVID-19 infection rate in US prisons.

Family Caregiver Alliance.Selected long-term care statistics.

Pew Research Center.Intent to get a COVID-19 vaccine rises to 60% as confidence in research and development process increases.

Helfand BKI, Webb M, Gartaganis SL, Fuller L, Kwon C, Inouye SK.The exclusion of older persons from vaccine and treatment trials for coronavirus disease 2019—missing the target.JAMA Intern Med.2020;180(11):1546–1549. doi:10.1001/jamainternmed.2020.5084

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