Older Patients, Wiser Care

What to Say When a Loved One Pooh-Poohs the Flu Shot

Last updated:

October 25, 2010

Dear Dr. K,

How can I convince my mom to get a flu shot? I want her to keep up with recommended preventive care, but she's been pooh-poohing me, saying she's already lived through plenty of flu seasons. Also, I've heard there's a new stronger flu shot available for older people this year. If I can talk my mom into getting vaccinated, should I push for her to get this new shot, or the usual one?

I'm not surprised to hear that your mom is skeptical of the flu shot. My own primary care clinic is currently offering flu shots to everyone who comes for a visit, but just this past week, I've been turned down by about a quarter of my own patients!

Here are some of the common reasons I hear for resisting vaccination, along with my usual responses:

"You can get the flu from the flu shot." No, you can't get the flu from the flu shot, because the injected flu vaccine contains only killed influenza virus. (The nasal vaccine does contain a weakened live virus, but that vaccine is only recommended for those under age 50.)

"The flu shot always makes me sick." Along with a sore arm, many people do also experience such side effects from the flu vaccine as feeling tired, achy, or getting a mild fever for a day. However, getting the flu itself generally feels much worse, lasts for longer, and can potentially turn into a life-threatening illness.

"I've had the flu before, and it isn't that bad." It's true that in many cases, the flu is unpleasant, yet not life-threatening. Most people get better without any medical treatment. As we age, however, our bodies often become less able to withstand the stress of the flu. That's why older people are more likely to be tipped into a dangerous pneumonia, or other complication, when they get the flu.

"Nobody knows if vaccines are truly safe." Although the seasonal flu vaccine gets reformulated every year for protection against the most current strains of flu, the basic method of manufacturing it has been the same for a long time. This is a vaccine with a good, safe track record.

"The flu shot doesn't work as well in older people." For the flu shot to work, the body's immune system needs to respond and make protective antibodies. And yes, as we age, the immune system often slows down, and either takes longer to make antibodies or makes less of them. That's why the new high-dose flu vaccine was created. Approved in December 2009, it contains four times more flu antigen than the usual vaccine. The more antigen in a vaccine, the more likely that the person will generate enough antibodies to protect from disease. The CDC hasn't yet taken a stance on whether older adults should get the high-dose shot rather than the usual one; instead the CDC says that either should be given. Even the regular shot decreases the risk of serious illness or death in older people, research shows.

Of course, unless your mother has dementia or some other problem that interferes with her ability to make medical decisions, you'll have to respect her choice. Still, it might help to gently explore her reasons for declining. Some older people do change their minds about the flu shot, once they've been given some additional information.

My prescription for caregivers about flu shots:

Go with your loved one so both of you can get a seasonal flu shot every fall. The CDC recommends that everyone over 6 months of age be vaccinated against flu this fall. They also identify all adults 65 and older as being "at high risk for flu-associated complications." Find a place to get a flu shot near you.

Pick either shot. People tend to report more minor side effects from the high-dose shot, though it probably affords more protection to those over 65.

Try getting the doctor to recommend the shot. Some "refuseniks" are more amenable to suggestions from health professionals than family members.

Don't panic if, ultimately, your loved one refuses to get a flu shot. Overall, the chance of dying of influenza in any given year is small. Being vaccinated certainly helps make this chance smaller. But not every older person is interested in doing everything possible to reduce the danger of illness. Although the benefits of vaccination are real, especially later in life, most people survive flu season whether or not they've been vaccinated.