Insulin management for elderly patients — the daily reality

Reviewed by the How To Help Your Elders Medical Advisory Process

Vaccinations do not stop being important after childhood. Older adults need specific vaccines that protect against diseases their aging immune systems are less equipped to fight, including flu, pneumonia, shingles, COVID-19, and tetanus. The CDC recommends a clear schedule for adults over 65, and most of these vaccines are covered by Medicare at no cost.

Older Adults Need More Vaccines Than Most People Realize

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 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 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 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. Nobody wants to hear "you should get this vaccine because you might get sick." It feels abstract. But the reality is that older people who are vaccinated against certain diseases fare dramatically better if they actually contract those diseases. The CDC reports that adults 65 and older account for 50% to 70% of flu-related hospitalizations and 70% to 85% of flu-related deaths each year in the United States. These are not small numbers.

The Vaccines That Matter

The CDC's Advisory Committee on Immunization Practices (ACIP) maintains specific recommendations for adults 65 and older. The list is longer than a lot of people realize.

The flu vaccine is annual. The CDC recommends that adults 65 and older receive either the high-dose flu vaccine (Fluzone High-Dose) or the adjuvanted flu vaccine (Fluad), both of which produce a stronger immune response than the standard-dose vaccine. According to the CDC, high-dose flu vaccine has been shown to be about 24% more effective than the standard dose in adults over 65. Your parent should get it every fall. It's not perfect, but it reduces the risk of serious flu complications and hospitalization.

The pneumococcal vaccines protect against pneumococcal disease, which can cause pneumonia, meningitis, and bloodstream infections. The CDC recommends that adults 65 and older who have never received a pneumococcal conjugate vaccine get PCV20 (Prevnar 20). If they previously received PCV13, they should also get PPSV23 (Pneumovax 23) if they haven't already. The recommendations have changed over the years, so if you're not sure what your parent has received, check with their doctor and ask to see the vaccination record.

The shingles vaccine (Shingrix) is recommended for adults 50 and older. The CDC reports that Shingrix is more than 90% effective at preventing shingles and postherpetic neuralgia, a chronic nerve pain that can last months or years after a shingles outbreak. 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. About one in three Americans will develop shingles in their lifetime, and the risk increases significantly with age.

COVID-19 vaccination continues to matter for older people. The CDC recommends that adults 65 and older stay current with updated COVID-19 vaccines. People over 65 who get COVID are at substantially higher risk for severe disease, hospitalization, and death. Updated vaccines are typically recommended annually, though boosters may be available more frequently during surges.

Tetanus and diphtheria boosters (Td) are needed every ten years throughout life. If your parent hasn't had a Tdap (tetanus, diphtheria, and pertussis) vaccine, they should get one dose and then continue with Td boosters every ten years. Pertussis (whooping cough) protection is especially relevant if your parent is around young grandchildren.

RSV (respiratory syncytial virus) vaccine was approved for adults 60 and older in 2023. The CDC recommends shared clinical decision-making for adults 60 to 74 and routine vaccination for those 75 and older. RSV can cause severe respiratory illness in older adults, leading to hospitalization and death.

Beyond these, there are vaccines for hepatitis B and other diseases that some older people should get depending on their risk factors. Your parent's doctor should evaluate which vaccines make sense for their specific situation.

Why Vaccination Is Different at This Age

The immune system weakens with age. This is a real physiological change called immunosenescence. 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? 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 partial protection matters enormously to an older person because they have less margin for error.

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 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 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. Facts won't fix this directly. 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 was skeptical too, but here's why I decided it was worth it."

Feeling like they don't need it is another category. Your parent feels fine. They're healthy. They've never had serious flu. They don't realize how quickly things can change, or they're in denial about their vulnerability. This is hard to address because the person isn't thinking about facts. They're thinking about identity: "I'm a healthy person, and healthy people don't need vaccines."

Fear of side effects is real and worth taking seriously. Some of the side effects from vaccines can feel unpleasant. The shingles vaccine sometimes causes a sore arm or a low fever. 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 uncomfortable 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. 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 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 pharmaceutical companies. I get that. 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. 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 the doctor to bring it up at the next appointment.

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

The Schedule

The flu vaccine is annual, ideally in September or October. It takes about two weeks for the vaccine to provide protection, so getting it early 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. CDC data show that Shingrix maintains over 85% effectiveness for at least four years after vaccination, with studies ongoing for longer duration.

The pneumococcal vaccine schedule depends on the specific vaccines and your parent's age and history. If they've never had any pneumococcal vaccine, one dose of PCV20 is the current recommendation. Your parent's doctor should know what's needed based on their vaccination history.

COVID vaccines currently follow an annual schedule, though this may change. Your parent should ask their doctor or check cdc.gov 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.

RSV vaccination is a single dose for those who qualify.

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.

Cost and Coverage

Medicare Part B covers the flu vaccine, pneumococcal vaccines, COVID-19 vaccines, and hepatitis B vaccines at no cost to the patient when administered by an in-network provider. Medicare Part D covers the shingles vaccine (Shingrix), RSV vaccine, and Tdap/Td vaccines, though copays may apply depending on the plan. Under the Inflation Reduction Act of 2022, all recommended adult vaccines are covered with no cost-sharing for Medicare Part D enrollees.

Medicaid coverage for vaccines varies by state, but most states cover CDC-recommended vaccines for adults.

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. The diseases themselves are far riskier than the vaccines. 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, means they can make the decision calmly rather than in a crisis.

Frequently Asked Questions

What vaccines does the CDC recommend for adults over 65?
The CDC recommends annual influenza vaccine (high-dose or adjuvanted formulation), pneumococcal vaccine (PCV20 if not previously vaccinated), shingles vaccine (Shingrix, two doses), up-to-date COVID-19 vaccination, Td or Tdap booster every 10 years, RSV vaccine for adults 75 and older (or shared clinical decision-making for ages 60 to 74), and hepatitis B vaccine for those with risk factors. Additional vaccines may be recommended based on individual health conditions and risk factors.

Does Medicare cover all recommended vaccines?
Medicare Part B covers flu, pneumococcal, COVID-19, and hepatitis B vaccines at no cost when administered by an in-network provider. Medicare Part D covers shingles (Shingrix), RSV, and Tdap/Td vaccines. Under the Inflation Reduction Act of 2022, Part D enrollees pay no cost-sharing for all ACIP-recommended vaccines. If your parent has a Medicare Advantage plan, vaccine coverage is generally the same as or better than Original Medicare.

My parent already had shingles. Do they still need the vaccine?
Yes. The CDC recommends Shingrix for adults who have already had shingles, because the virus remains dormant in the body and can reactivate again. Your parent should wait until the shingles rash has completely resolved before getting vaccinated. Shingrix is still more than 90% effective at preventing future episodes in people who have already had shingles.

Are there side effects from vaccines in older adults?
Common side effects include soreness at the injection site, mild fatigue, low-grade fever, and muscle aches. These typically resolve within one to three days. The shingles vaccine (Shingrix) tends to cause more noticeable side effects than most other vaccines, but they are still mild and temporary. Serious allergic reactions are rare. The side effects of the vaccines are consistently less severe than the diseases they prevent.

How do I find out which vaccines my parent has already received?
Start with their primary care doctor's office, which should have vaccination records. Pharmacies that administered vaccines also keep records. Your state may have an immunization information system (immunization registry) that tracks vaccinations. Medicare claims records can show vaccines that were billed. If records can't be located, most vaccines can safely be repeated, and your parent's doctor can create a catch-up schedule.