Which vaccinations belong to healthy ageing?
For healthy ageing, the flu vaccine (high dose), the pneumococcal vaccine, the shingles vaccine, and the RSV vaccine are well supported for people aged 60 and older; discuss which ones you are still missing with your GP or pharmacist.
Four vaccines have the strongest evidence base for people aged 60 and older. The flu vaccine comes first: influenza is the infectious disease responsible for the most deaths in this age group. For older adults, a higher dose works better than the standard vaccine, because the immune system responds less vigorously with age. Yet Germany does not meet the WHO target of 75% vaccination coverage in older adults. The same is true for other countries.
The pneumococcal vaccine protects against bacteria that can cause severe pneumonia and blood poisoning. The shingles vaccine prevents shingles and the nerve pain that can sometimes follow for months. Both vaccines are recommended, but many older adults skip them because they feel healthy and underestimate the risk. Research in North Dakota shows that older adults refuse the shingles vaccine more often than other vaccines.
RSV (the respiratory virus also well known for affecting babies) is dangerous for older adults too. Two vaccines for it were approved in the United States in 2023. A summary of multiple studies showed protection of over 78% against RSV lung infection and 87% against severe cases, with no meaningfully greater side effects than with a placebo. Doctors recommend this vaccine on a case-by-case basis, especially for people aged 65 and older; for the 60-64 age group, cost-effectiveness is less certain.
The Tdap booster shot (tetanus, diphtheria, and whooping cough in one) is also relevant. Whooping cough is occurring more and more frequently in adults and older adults, because the protection from earlier vaccinations wanes over time. In older adults with underlying conditions, whooping cough can take a severe course. The evidence for the booster shot in older adults is less strong than for the other vaccines; the studies on this topic are more limited in design. Several authors of the article in question have financial ties to a vaccine manufacturer, which makes it sensible to take this fact into account.
A practical advantage: having multiple vaccines given at the same time is safe and saves hospital visits. In children this has been standard practice for many years; in adults it is still done too infrequently. Accessible settings such as pharmacies can help to increase vaccination rates.
All claims are based on guidelines, a meta-analysis (RSV), and observational/descriptive research. For RSV there is a meta-analysis with quantitative effect sizes. For influenza, pneumococcal disease, and shingles, recommendations are based on guidelines and descriptive studies without exact effect sizes in the supplied abstracts. For Tdap, the evidence in older adults is limited and there are potential conflicts of interest among the authors.
Does your immune system really weaken as you get older, and can you do anything about it?
Your immune system demonstrably weakens with age, but eating healthily and exercising can reduce the smouldering inflammation that accompanies it. It is still too early to rely on drugs targeting senescent cells.
Does spending more time outdoors help your immune system as you get older?
Spending more time outdoors may support your immune system as you get older, mainly through improved vitamin D production, but whether this actually leads to less illness has not yet been conclusively demonstrated. How polluted the outdoor air is also matters: in areas with serious air pollution, being outside can in fact be detrimental.
Can you slow down the ageing of your immune system?
You can partly limit the consequences of an ageing immune system, especially with more cleverly designed vaccines such as adjuvant-enhanced flu vaccines and possibly the shingles vaccine. Whether you can slow the ageing process itself remains an open question.
Does your immune system really weaken as you get older?
Your immune system does indeed weaken as you get older, but how quickly that happens varies considerably from person to person. Lifestyle factors play a role in this, although little has yet been proven specifically for humans.
Why are older adults more susceptible to influenza?
Older adults are more susceptible to influenza because their immune system functions less well with age, meaning they are both more likely to become seriously ill and less able to build up protection through vaccination. Vaccination nonetheless remains worthwhile, even though the protection it offers older adults is smaller than that for younger people.
Does exercise help your immune system as you age?
Regular, moderate exercise helps your immune system by reducing smouldering inflammation. Suddenly training very hard without a gradual build-up can actually temporarily lower your immune defences.