Stop Treating 70- and 90-Year-Olds the Same

Harry Campbell

Every summer around this time, pediatricians’ offices are flooded with children getting the vaccines they need to start another year of school.

Doctors base their advice on which shots patients should get when on the Centers for Disease Control and Prevention’s vaccine recommendations. The guidelines are presented in two schedules, one for children, the other for adults, both divided into subgroups based on developmental biology and social behaviors common at different ages. Unfortunately, there’s a major problem with the guidelines. And it’s representative of a larger failing in our health care system.

There are 17 subgroupings for children from birth through age 18. That makes sense because, of course, a 6-month-old has had little time to develop immunity, weighs far less than an 8-year-old and is exposed to fewer people than a teenager. There are five subgroups for adults. But all Americans 65 and older — including the two fastest-growing segments of our population, the 80- to 90-year-olds and those over 100 — are lumped in a single group, as if bodies and behaviors don’t change over the last half-century of life.

You don’t need to be a doctor to see that this is absurd. Just as we don’t confuse toddlers with teenagers, or young adults with their middle-age parents, so, too, are we able to distinguish 70-year-olds from the nonagenarians a generation ahead of them.

Those two groups — the “young old” and the “old old” — don’t just differ in how they look and spend their days; they also differ biologically. As a result, it’s likely that we are incorrectly vaccinating a significant number of the 47 million Americans over 65.

With advancing age, the immune system weakens (a phenomenon called immunosenescence) and chronic diseases compromise the body’s resistance to infectious organisms. Older adults are thus more susceptible to infections — more likely to get sick, more likely to require hospitalization and more likely to die.

At the same time, immunizations provide less protection. Older adults who receive tetanus and diphtheria vaccines, for instance, produce less-effective antibodies, and the vaccines’ protective effect fades faster than it does for younger patients. Older people may need different dosing or even biologically different vaccines.

Given lengthening life spans, we may also be routinely undervaccinating older adults. The C.D.C. recommends one dose of the shingles vaccine at 65, but we don’t know whether that shot protects people over 85, when the lifetime risk of disease exceeds 50 percent. We give children boosters to maintain immunity,…