Influenza vaccination for all elderly.

In the elderly, incidence, morbidity, complications, and mortality due to influenza are greatly underestimated. There are several reasons why influenza vaccination is unjustly denied to many elderly. In a number of countries such as the United Kingdom and The Netherlands, health authorities do not recommend to vaccinate all elderly persons above a certain age, and influenza vaccination is offered only to those with conventional risk factors such as cardiac or pulmonary disease. However, conventional risk factors are often not present or are not recognized in the elderly. There now is convincing evidence that age in itself leads to increased vulnerability and thus is a risk factor for influenza and its complications. It no longer seems justified not to vaccinate all elderly, including the healthy, against influenza.

[Extension of life, at what price? Consequences for health care of the elderly]. / Levensverlenging, tot welke prijs? Gevolgen voor de gezondheidszorg voor de oudere mens.

Prolonging life only makes sense if quality of life is maintained. In biomedical terms this means that life extension should not be accomplished at the cost of an increase of morbidity and dependence. The survival curve must maintain its rectangular shape and compression of morbidity should be sought for. Ageing is not synonymous with disease, and a healthy old age certainly is possible. Many disorders of old age are a result of extrinsic, avoidable factors such as drinking, smoking, eating habits, and inactivity. Prevention must begin in youth. This is the price to be paid by the individual. The medical and scientific community should increase its efforts to develop health care for the aged and increase investments in the study of the ageing process itself. Society as a whole can give support by funding the development of geriatrics and gerontology, and by improving the position and the acceptance of the elderly in daily life.

Necessity of the assessment of health status in human immunogerontological studies: evaluation of the SENIEUR protocol.

Disease is frequent in ageing, and the many conflicting results in studies of the ageing process can be due to the presence of factors such as underlying disease or the use of medication. For immunogerontology, a solution to this problem was initiated in 1984 by a working party of EURAGE, the European Community's Concerted Action Programme on Ageing and Diseases. A protocol defining strict admission criteria to studies of ageing, the SENIEUR protocol, was elaborated. This protocol intends to limit the influence of disease and/or medication and to standardize admission criteria to immunogerontological studies. In subjects fulfilling the SENIEUR criteria, we found less immunological defects with ageing than generally stated. This could mean that many studies performed in not-optimally healthy subjects describe defects that are not a consequence of the ageing process, but could be a result of underlying disease or of the influence of medication. For lymphocyte subsets, certain changes are only found in the comparison of SENIEUR groups of young and aged, while other changes are only found when non-healthy groups are compared. The occurrence of monoclonal gammopathies and autoantibodies was increased in ageing, but was also influenced by health status. Experience of other groups, and the objections against the protocol are discussed.