The fear of loss of autonomy as lever for vaccination of the elderly: a qualitative study

The COVID-19 pandemic has highlighted the challenges of vaccination and the infectious risks among the elderly. According to available data, vaccination rates for recommended vaccines in this population are insufficient in France. The aim is to identify the levers and obstacles to vaccination among seniors, and then to shed light on the possible arguments that could lead to a commitment to new vaccination behaviours. A qualitative survey based on 14 semi-structured interviews was conducted with people aged 65 and over, living at home in the Auvergne Rhône-Alpes region (France) from March to May 2022. The interviews were recorded, transcribed in their entirety and then subjected to a thematic content analysis by two independent persons. The participants declared themselves to be in good health and to be concerned about maintaining their health by keeping their physical and cognitive capacities and their autonomy. To this end, they mentioned carrying out preventive behaviours, such as regular physical activity and a balanced diet. However, vaccination, which is associated with infectious disease prevention, was not mentioned as a factor in the prevention of good ageing during the interviews. Participants’ experiences of the polio epidemic and the COVID-19 pandemic highlighted older people's fears of infections. While infections are not a source of fear, their after-effects, more specifically, physical and cognitive alterations leading to a loss of autonomy, are a source of apprehension. These elements could be a good lever to bring hesitant elderly people to think about their own vaccination. In the light of these elements, given the protection against cardiovascular events provided by vaccinations for the elderly (influenza, shingles, pneumococcus), this argument could be the starting point for a prevention campaign aimed at the elderly. This avenue will be tested more precisely and with a larger number of subjects in a quantitative study based on a questionnaire. KEY MESSAGES: • the protection against cardiovascular events provided by vaccinations for the elderly (influenza, shingles, pneumococcus) seems to be argument could be change vaccination behavior. • Older people are not afraid of infections but of the consequences they can have, such as loss of autonomy.