BACKGROUND: Despite high vaccine effectiveness in preventing community-acquired pneumonia and influenza, vaccination coverage rates remain sub-optimal in high risk populations such as the elderly. Lack of recommendation by healthcare providers has been identified to be associated with low vaccination coverage rates.

OBJECTIVES: To quantify missed opportunities for influenza and pneumococcal vaccinations in the elderly ≥years. Vaccination coverage and factors associated with vaccination were also examined.

METHODS: A retrospective cross-sectional analysis was conducted using the 2015 National Health Interview Survey. All respondents ≥65 years were included. Respondents with zero/non-positive survey weights and those with missing values for vaccination status were excluded. Missed opportunities for vaccinations was defined as the number of healthcare encounters in patients unvaccinated despite hospitalization, emergency room(ER), home and doctor’s office visits. Multi-variable logistic regression was used to identify factors associated with vaccination coverage.

RESULTS: 8,046 respondents representing a population of 24,306,590 individuals aged 74.1 (± 6.6) years were included in the study. An average of 5.32 (95% CI: 5.03-5.61) missed opportunities for influenza vaccinations and 5.15 (95%CI: 4.90-5.39) for pneumococcal vaccinations were observed. Office visits accounted for majority of these missed opportunities. For both vaccines, lowest coverage rates were recorded for those with 1-3 office visits. Highest influenza vaccine coverage rate (75.8%) was recorded for respondents who had seen a Nurse Practitioner/Physician Assistant/midwife while the highest pneumococcal vaccine coverage rate (76.2%) was recorded for respondents with home visits from a healthcare professional. Factors associated with vaccination coverage include increased age, being non-Hispanic white, married, insured, co-existing asthma, heart disease, COPD, diabetes or cancer. Hospitalization and ER visit were not associated with vaccination coverage.

CONCLUSIONS: Significant missed opportunities exist for both vaccinations in the elderly. Increased focus on vaccinations during office visits or vaccinations programs outside healthcare settings may significantly increase vaccine coverage rates.