title: The impact of dementia on influenza vaccination uptake in community and care home residents.
abstract: BACKGROUND
  Influenza vaccination is recommended for older people irrespective of cognitive decline or residential setting.
  
  
  OBJECTIVE
  To examine the effect of dementia diagnosis on flu vaccination uptake in community and care home residents in England and Wales.
  
  
  METHODS
  Retrospective analysis of a primary care database with 378,462 community and 9,106 care (nursing and residential) home residents aged 65-104 in 2008-09. Predictors of vaccine uptake were examined adjusted for age, sex, area deprivation and major chronic diseases.
  
  
  RESULTS
  Age and sex standardised uptake of influenza vaccine was 74.7% (95% CI: 73.7-75.8%) in community patients without dementia, 71.4% (69.3-73.5%) in community patients with dementia, 80.5% (78.9-82.2%) in care home patients without dementia and 83.3% (81.4-85.3%) in care home patients with dementia. In a fully adjusted model, compared with community patients without dementia, patients with dementia in the community were less likely to receive vaccination (RR: 0.96, 95% CI: 0.94-0.97) while care home patients with (RR: 1.06, 1.03-1.09) and without (RR: 1.03, 1.01-1.05) dementia were more likely to receive vaccination. Area deprivation and chronic diseases were, respectively, negative and positive predictors of uptake.
  
  
  CONCLUSIONS
  Lower influenza vaccine uptake among community patients with dementia, compared with care home residents, suggests organisational barriers to community uptake but high uptake among patients with dementia in care homes does not suggest concern over informed consent acts as a barrier. Primary care for community patients with dementia needs to ensure that they receive all appropriate preventive interventions.
authors.affiliation: Population Health Sciences and Education, St George' s University of London, London, UK. sushah@sgul.ac.uk
authors.forename: Sunil M
authors.initials: SM
authors.lastname: Shah
authors.forename: Iain M
authors.initials: IM
authors.lastname: Carey
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
authors.forename: Stephen
authors.initials: S
authors.lastname: DeWilde
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003704:Dementia / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014611:Vaccination; D014852:Wales / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines