Vaccination: The missing piece in elderly healthcare
As we get older, staying healthy isn’t just about eating right or going for morning walks — it’s also about keeping our immunity strong. That’s where vaccination steps in. Many adults don’t realise that vaccines aren’t just for kids; they’re a huge part of protecting ageing bodies from serious infections. With age, our immune system slows down, making us more vulnerable to illnesses that could easily be prevented. So, talking about vaccines shouldn’t be an afterthought — it should be a key part of every healthcare conversation for ageing adults who want to stay active, independent, and worry-free, says Dr Randeep Guleria, former AIIMS New Delhi Director and the current President of AIIMS Bilaspur.
Why does vaccination need to be an important part of healthcare conversations for ageing adults?
Dr Randeep Guleria: Due to declining birth rates and increasing life expectancy, India is witnessing a steady rise in the ageing population. A recent WHO study highlights that the world is ageing faster than ever before and by 2050, nearly 67% of older people will live in low- and middle-income countries like India.
Now as people age, their immune function naturally declines, regardless of their overall health. This process is known as immunosenescence. This decline reduces the ability of immune cells to produce antibodies and recognise infections effectively, making older adults more susceptible to certain diseases and their complications, even if they were vaccinated as children.
This demographic shift is also accompanied by a higher prevalence of chronic conditions such as diabetes, hypertension, cardiovascular diseases, cancer, and COPD. These underlying health issues make older adults more vulnerable to vaccine preventable infections like influenza, shingles, and pneumonia, as well as to their serious complications.
As India’s population ages and more people live with long-term illnesses, a large segment of society faces increased health risks. Integrating vaccination into adult healthcare is no longer optional. It is essential to protect the health and the quality of life of the growing older population.
How do chronic diseases make adults more vulnerable to infections like flu, pneumonia or shingles that vaccines can prevent?
Dr Randeep Guleria: Chronic diseases weaken the body’s ability to fight infections in several ways. They can make the already weakening immune system of an ageing adult even more compromised by indirectly affecting it. .For example, diabetes impairs white blood cell function, making it harder for the body to fight off bacteria and viruses. In CKD, as the kidney damage progresses, immune cells become fatigued and less responsive, leading to a premature form of immune ageing. In fact, people with CKD can experience immunosenescence nearly 20 years earlier than healthy adults of the same age. In some chronic conditions, the immune system may mistakenly attack the body’s own tissues (autoimmunity), or it may become less responsive, increasing susceptibility to infections.
For people living with chronic conditions, these preventable infections may lead to hospitalisation, prolonged recovery, or worsening of their primary condition. For example, diabetes is linked to a greater risk of postherpetic neuralgia (PHN), a painful complication of shingles that can last for months or even years, significantly affecting quality of life. Managing shingles and PHN in people with diabetes can become more challenging due to existing complications like diabetic neuropathy (nerve damage) or diabetic nephropathy (kidney damage), which can slow down recovery.
Vaccination is therefore especially important for adults with NCDs. It not only prevents these infections but also helps avoid serious complications.
Why do you think adult vaccination remains so under-discussed, despite longer lifespans and changing health patterns? What are the biggest misconceptions holding adults back from getting vaccinated?
Dr Randeep Guleria: Despite living longer and facing evolving health risks, adult vaccination remains under-discussed largely because preventive health has not yet become part of routine healthcare conversations in India. Various surveys underline this gap. For instance, an API-Ipsos survey 2023, found that while 71% of adults over 50 recognise that vaccination is important for overall health, but only 22% are aware of vaccinations available to them. Even among doctors, 91% agree vaccination is vital for healthy ageing, yet only 16% recommended it to their older patients. Another Indian survey revealed that although 44% of adults above 50 live with a chronic condition, only half acknowledge their higher risk of infections like shingles. Adults even being vulnerable fail to anticipate their vulnerability and seek medical advice only when symptoms are visible. The API-Ipsos survey further showed this behaviour — 49% of the surveyed shingles patients did not recognise the shingles rash and thought it was an allergic skin reaction. They used moisturisers to overcome whatever discomfort they felt and took painkillers to manage the pain that often accompanies the rash. In fact, 36% of patients used home remedies and went to a doctor only when these did not work.
While several medical bodies have issued recommendations for adult vaccination, the absence of official government guidelines continues to limit awareness and uptake. This combination of low-risk perception, limited knowledge, and lack of structured programmes explains why adult immunisation coverage remains poor in India.
What are the specific infections that become a concern as people age, and how can vaccination help prevent them?
Dr Randeep Guleria: Ageing adults, especially those living with chronic conditions, are at a significantly higher risk for various infections like influenza, pneumonia, and shingles. These infections can be debilitating as people age and lead to severe complications. Take for example shingles. It occurs when the varicella-zoster virus, which causes chickenpox and remains dormant in the body after the initial infection, becomes reactivated due to a weakened immune system. The most defining symptom of shingles is a painful, blistering rash that typically appears on one side of the body. But shingles is not just a skin condition. The pain can be excruciating often compared to labour pain # and may persist long after the rash disappears. This long-term nerve pain, called postherpetic neuralgia (PHN), can be debilitating in older adults, making even simple activities difficult. PHN occurs more frequently and severely in adults aged 50 years and above. Vaccination is one of the most effective ways to protect against this painful disease and its complication in people aged 50 years and above.
Similarly, flu is another infection that can become severe in older adults and lead to serious complications. In this age group, it can affect more than just the lungs. It can make existing health problems worse, trigger heart attacks or strokes, and lead to a loss of strength and independence.
Moreover, the presence of any chronic disease in older adults increases the risk of developing flu and flu-related complications, including hospitalization, catastrophic disability, and even death. Vaccination can be a vital step for protection and prevention against this infection.
By stimulating the immune system, vaccinations help the body recognise and fight infections more effectively. They also help reinforce immune protection later in life, countering the natural decline in immunity that comes with ageing.
Are there specific vaccines currently recommended for adults in India?
Dr Randeep Guleria: Although India currently lacks a government directive on adult vaccination, several medical societies have come together along with the Association of Physicians of India to issue guidelines for adult immunisation. These guidelines emphasize vaccinations for influenza, pneumococcal disease, hepatitis B, HPV, RSV and shingles for adults of 50 years and above and specially in higher-risk groups with chronic illnesses.
What steps should India take to transition from a reactive to a preventive healthcare approach especially in the context of our ageing population?
Dr Randeep Guleria: India should transition to preventive healthcare by establishing robust adult vaccination programs with national guidelines tailored to diverse adult populations and their health risks. The success of the Universal Immunisation Programme (UIP), which has achieved high coverage and protected millions of children, offers valuable lessons that can be replicated for adults such as strong public–private partnerships, streamlined delivery systems, and large-scale awareness initiatives. Building on this foundation, India can create dedicated vaccination centers, educate healthcare providers, integrate vaccination into routine chronic disease management, and run targeted public awareness campaigns to dispel myths. With 75% of older adults living with chronic diseases and 20% of India’s population projected to be elderly by 2050, such proactive measures can reduce disease burden, healthcare costs, and improve healthy ageing trajectory.
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