How Elderly People With Chronic Diseases Can Evaluate Whether To Receive The Covid-19 Vaccine

But people 65 years and older on cancer treatment were not included in these studies. As a result, it is not clear what degree of protection they might get.

Regarding safety, there is no evidence at this time that cancer patients are more likely to experience side effects from Pfizer-BioNTech and Moderna vaccines than other people. In general, “we are confident that these vaccines are safe for (cancer) patients,” including older patients, said Dr Armin Shahrokni, geriatrician and oncologist at Memorial Sloan Kettering.

The exception, which applies to everyone, not just cancer patients: People who are allergic to components of the Covid-19 vaccine or who have severe allergic reactions after receiving a first vaccine should not receive the Covid vaccine. 19.

Efficacy is a consideration for patients whose underlying cancer or treatment suppresses their immune system. In particular, patients with cancers of the blood and lymph nodes may show a blunt response to vaccines, as well as patients undergoing chemotherapy or radiation therapy.

Even then, “we have every reason to believe that if their immune system is working at all, they will respond to the vaccine to some extent,” and that will likely be beneficial, said Dr William Dale, president of supportive care. . medicine and director of the Center for Cancer Aging Research at City of Hope, a comprehensive Los Angeles County cancer center.

In some cases, it can be helpful to find a balance between the timing of cancer treatment and vaccination. For people with serious illness who “need therapy as soon as possible, we must not delay treatment (of cancer) because we want to preserve immune function and vaccinate them” against Covid, said Hohl from Memorial Sloan Kettering.

One approach could be to try to time the Covid vaccination “between cycles of chemotherapy, if possible,” said Dr Catherine Liu, a professor in the division of vaccines and infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle.

American Cancer Society medical and scientific director Dr. William Cance said his organization was “strongly in favor of immunization of cancer patients and cancer survivors, especially the elderly.” Given vaccine shortages, he also recommended that cancer patients who contract Covid-19 get antibody treatments as soon as possible, if their oncologists believe they are good candidates. These infusion therapies, from Eli Lilly and Co. and Regeneron Pharmaceuticals, rely on synthetic immune cells to help fight infections.

Q: Should my 97-year-old mother in a nursing home with dementia even get the Covid vaccine?

The Alzheimer’s Association also strongly encourages vaccination against Covid-19, “both for people (with dementia) living in long-term care and those living in the community,” said Beth Kallmyer, vice president of care and support.

“What I think this question is trying to ask is, ‘Will my loved one live long enough to see the benefits of being vaccinated? “Said Dr. Joshua Uy, medical director of a Philadelphia nursing home and director of the Geriatric Fellowship at the University of Pennsylvania Perelman School of Medicine.

Potential benefits include not getting sick or dying from Covid-19, having visits from family or friends, engaging with other residents and participating in activities, suggested Uy. (This is a partial list.) Since these benefits might start to accrue a few weeks after fully immunizing residents of an institution, “I would recommend the vaccine for a 97 year old child with significant dementia,” declared Uy.

Minimizing suffering is a key consideration, said Dr. Michael Rafii, associate professor of clinical neurology at the Keck School of Medicine at the University of Southern California. “Even if a person has terminal dementia, you want to do everything you can to reduce the risk of suffering. And this vaccine offers people good protection against serious Covid disease, ”he said.

“My advice is that everyone should get the vaccine, regardless of what stage of dementia they are in,” Rafii said. This includes patients with dementia at the end of their life in palliative care, he noted.

If possible, a loved one should be on hand for reassurance, as being approached by someone wearing a mask and wearing a needle can cause anxiety in patients with dementia. “Ask the person administering the vaccine to explain who they are, what they do and why they wear a mask in plain language,” Rafii suggested.

Q: I am 80 years old and have type 2 diabetes and autoimmune disease. Should I get the vaccine?

There are two parts to this question. The first concerns “co-morbidities” – having more than one medical condition. Should elderly people with co-morbidities be vaccinated against Covid?

Absolutely, because they are at a higher risk of becoming seriously ill from Covid, said Dr Abinash Virk, infectious disease specialist and Mayo Clinic’s Covid-19 vaccine deployment co-chair.

“The Pfizer and Moderna studies specifically looked at older people with co-morbidities, and they showed that the vaccine response was similar to that of younger people,” she noted.

The second part is about autoimmune diseases such as lupus or rheumatoid arthritis, which also put people at higher risk. The concern here is that a vaccine could trigger inflammatory responses that could make these conditions worse.

Philippa Marrack, director of the Department of Immunology and Genomic Medicine at National Jewish Health in Denver, said there was no scientifically rigorous data on how patients with autoimmune diseases respond to Pfizer vaccines and Moderna.

So far, the grounds for concern have not emerged. “Over 100,000 people have received these vaccines now, including some who likely had autoimmune disease, and there have been no systematic reports of problems,” Marrack said. If patients with autoimmune diseases are really worried, they should discuss with their doctors about postponing vaccination until other Covid vaccines with different formulations are available, she suggested.

Last week, the National Multiple Sclerosis Society recommended that most patients with multiple sclerosis – another serious autoimmune disease – receive the Pfizer or Moderna Covid vaccines.