Insulin management for elderly patients — the daily reality

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your mother says she's already had all her vaccinations. She got polio vaccine as a child. She got tetanus shots. That's enough, she thinks. She's not trying to be difficult. She genuinely believes that vaccines are something you get once and then you're done, the way you get a driver's license and it lasts for years. She doesn't understand that there are vaccines she needs now that are specifically designed for people her age, or that some of the vaccines she got decades ago have waned and she needs boosters, or that new vaccines exist now that didn't exist when she was younger.

Your father is more resistant. He's heard things about vaccines, things that make him uncomfortable. He's heard stories about side effects. He thinks his immune system should be able to handle what comes along, the way it did when he was young. He's skeptical of anything that feels like fear-mongering, and the way some vaccination campaigns are promoted makes him feel like someone is trying to scare him into something. He's not against vaccines exactly. He's just not convinced he needs them, and there's no one trusted voice telling him why it matters.

This is one of the conversations you're going to have with your aging parent whether you planned it or not. It's important, but it's also often frustrating because it's hard to convey urgency around something that feels preventive. Nobody wants to hear "you should get this vaccine because you might get sick." It feels abstract. It feels like overcautious worry. But the reality is that older people who are vaccinated against certain diseases fare dramatically better if they actually get those diseases, and the diseases that matter for older people are the ones that can be genuinely dangerous.

The Vaccines That Matter

Start with the specifics because the recommendation list is longer than a lot of people realize. Your aging parent probably needs more vaccines than they have.

The flu vaccine is annual, and this one most people understand. Your parent should get it every fall. It's not perfect, but it reduces the risk of serious flu and the risk of complications. For older people, flu can lead to pneumonia quickly. The vaccine helps prevent that progression.

The pneumonia vaccine comes in two shots now, and this is where things get more confusing. There's the standard pneumococcal vaccine that most older people should get at least once. There's also a newer vaccine that covers additional strains. The recommendations change, and whether your parent needs one, two, or both depends on their age and whether they've had pneumococcal vaccines before. Your parent's doctor should know the current recommendations, but honestly, they sometimes don't. If you're not sure what your parent has gotten, ask to see the vaccination record.

The shingles vaccine is important for people over fifty, and this is one where people sometimes resist because they remember when shingles was just something you dealt with. Now there's a vaccine that prevents it, and it prevents it pretty reliably. The vaccine is given in two shots two to six months apart. Some people have a sore arm or mild fever after the vaccine. Those side effects are minor compared to actual shingles, which is extremely painful and can have long-term complications. This is a vaccine worth insisting on if your parent is reluctant.

COVID-19 vaccination continues to matter for older people. The recommendations change, but generally older people should stay current with whatever the current recommendation is. For someone over seventy-five, or someone with underlying health conditions, staying up-to-date with COVID vaccines matters because older people who get COVID are at higher risk for severe disease. Some people got vaccinated once and think they're done. That's not how it works anymore. There are annual boosters or updated vaccines depending on the current variants and the current recommendations.

Tetanus boosters are needed every ten years throughout life. Your parent probably knows about tetanus shots, but they might not realize they still need them. If your parent had tetanus vaccination as a child or as an adult, they need a booster every ten years. If they haven't had one in a while, they need to catch up.

Beyond these, there are vaccines for other diseases—hepatitis, pertussis, tuberculosis in certain situations—that some older people should get depending on their risk factors. Your parent's doctor should be able to talk about which vaccines make sense for your parent's specific situation.

Why Vaccination Is Different at This Age

Here's the part that confuses people and that sometimes makes them think vaccination is less important for older people. The immune system weakens with age. This is a real physiological change, not something anyone is imagining. Older people don't mount as strong an immune response to vaccines. The antibodies they develop might be lower. The duration of protection might be shorter.

So someone might think: if the vaccine doesn't work as well in older people, why bother? But that logic is backwards. Yes, the immune response is weaker. But the consequence of actually getting these diseases is far worse in older people. Your parent's weaker immune system means they're more vulnerable to severe complications if they actually get the flu or pneumonia or COVID. The vaccine still provides protection, just not perfect protection. That protection matters a lot more to an older person than to a younger person because they have less margin for error.

Think of it this way. A younger person gets the flu and is sick for a week and recovers. An older person gets the flu and might end up in the hospital with pneumonia. A younger person gets COVID and has some rough days. An older person gets COVID and might have organ damage or long COVID that affects them for months. The vaccine isn't perfect for the older person, but it's not trying to be perfect. It's trying to reduce the risk of severe disease. And for an older person, that's what matters.

The Resistance

You're probably going to encounter resistance, and understanding what's behind it helps you figure out how to address it.

Distrust is one category. Your parent has heard things—conspiracy theories, exaggerated anecdotes, stories of side effects that might or might not be real. They don't trust the government. They don't trust pharmaceutical companies. They think people are making money off their worry. This is hard to argue with because it's not really an argument. It's a feeling of mistrust that's deeper than facts can reach. Facts won't fix this. What sometimes helps is having their trusted doctor, someone they've known for years and who they actually believe is on their side, explain why the vaccine matters. What sometimes helps is other family members they trust saying "yes, I get it, I was skeptical too, but here's why I decided it was worth it."

Feeling like they don't need it is another one. Your parent feels fine. They're healthy. They've never had serious flu. Why would they need a vaccine? They don't realize how quickly things can change, or they're in denial about their vulnerability. Older people sometimes have a sense that their body will handle what comes along the way it did when they were younger. They don't understand that at eighty, the vulnerabilities are actually different. Again, this is hard to address with facts because the person isn't really thinking about facts. They're thinking about identity. They're thinking "I'm a healthy person, and healthy people don't need vaccines."

Fear of side effects is real and important. Some of the side effects from vaccines can feel worse than the disease itself in the moment. The shingles vaccine, for example, sometimes causes a sore arm or a low fever. For someone who's had bad reactions to medications, or who's anxious about medical things, the idea of voluntarily getting a shot that makes them feel worse for a day or two feels wrong. What sometimes helps here is information. Understanding that most side effects are mild and temporary, that serious side effects are rare, that the side effects from the actual disease are far worse. Talking to someone else who got the vaccine and had the experience of feeling a bit crummy for a day and then being fine.

Forgetfulness is a category too. Your parent knows they should get vaccines. They just don't think about it until the moment has passed. The season changes. They never actually got around to going to get the flu vaccine. Then it's March and the season is almost over. The doctor never brought it up during the appointment. So it never happened. This is an easier problem to solve. You put it on the calendar. You make the appointment. You drive them if necessary. You remove the friction.

Having the Conversation

If your parent is resistant, you're going to need to have a conversation. This conversation is more likely to go well if you're not trying to force someone to do something. You're trying to help them make a decision based on information.

Start by understanding their specific concern. Don't assume you know why they're reluctant. Ask. "I notice you haven't gotten the flu vaccine. What's making you hesitant?" Listen to the answer. If they say they're worried about side effects, acknowledge that. If they say they don't think they need it, listen to why they think that. If they say they don't trust vaccines, ask what they've heard that's made them skeptical. You're not going to argue them out of their position. But you might understand it.

Share information that matters. If the concern is side effects, share information about how common side effects actually are, and how they compare to the disease itself. If the concern is whether the vaccine works, share information about efficacy. If the concern is distrust, you might not be able to fix that, but you can acknowledge it. "I know you're skeptical of big pharmaceutical companies. I get that. I'm skeptical too. But in this specific case, the risks of not getting vaccinated seem higher than the risks of the vaccine itself."

Have their trusted doctor do some of the talking. This is why it matters to have a good relationship with your parent's primary care doctor. When the doctor says "I really think you should get this vaccine, and here's why," it lands differently than when their adult child says it. You can ask their doctor to bring it up. You can ask their doctor to explain why it matters. You can attend the appointment with them and let the doctor address the concerns.

Sometimes a peer voice helps. If you know someone your parent's age who's been vaccinated, who's had maybe a minor side effect that resolved quickly, who's decided it was worth it, that conversation sometimes helps. Stories are more powerful than statistics.

Look for agreement on small things. Your parent might not agree that they need the COVID vaccine. But maybe they agree they should get the flu vaccine. Start there. You're not going to win every conversation. Sometimes you get the flu vaccine done and you agree to revisit the others. That's progress.

The Schedule

Here's a practical question: what's actually supposed to happen and when.

The flu vaccine is annual, ideally in the fall. It takes about two weeks for the vaccine to provide protection, so getting it in September or October gives your parent protection through the winter months when flu is most common.

The shingles vaccine is two doses two to six months apart. Once someone gets both doses, they have lasting protection. Your parent can get the first dose any time, but usually people do it in a season when they're likely to be healthy and not dealing with other illnesses.

The pneumonia vaccines depend on the specific vaccines and your parent's age and history. The current recommendation is complicated and changes sometimes. Your parent's doctor should know what your parent needs. If you're not sure, ask the doctor to write down the recommendation so you have it clearly.

COVID vaccines currently follow an annual schedule, though this might change if variants change or if recommendations change. Your parent should ask their doctor or check the CDC website for the current recommendation.

Tetanus boosters need to happen every ten years. If your parent can't remember when they last got a tetanus shot, they probably need one. It's safe to get it even if they're not sure about timing.

Some facilities require certain vaccines for admission. If your parent is considering an assisted living facility or nursing home, that facility might require flu vaccine, COVID vaccine, and others. This is something to ask about if your parent is resistant,sometimes "the facility requires it" is more persuasive than anything you say.

The point is not to make this more complicated than it needs to be. The goal is straightforward: your parent should be vaccinated against diseases that are dangerous for older people, because vaccinated older people who get those diseases do better. Some side effects from vaccines are possible. Serious side effects are rare. The diseases themselves are far riskier. Your parent doesn't have to take your word for this. Their doctor can explain it. But having this conversation now, before your parent is sick, before they're vulnerable, means they can make the decision calmly rather than in a crisis.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you have questions about which vaccinations your loved one needs, consult with their healthcare provider about their individual health status and risk factors.