Older adults are among those most at risk of becoming seriously ill from COVID-19. This is why people who live in nursing homes or other long-term care facilities are expected to be among the first offered the new COVID-19 vaccines. It’s okay to have a lot of questions. You might be wondering, Is it ok to get a vaccine if you have another health problem? What are the side effects? In this Q&A, R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, addresses some of the common questions older adults may have about these new vaccines.
When will vaccines be available for older adults living in nursing homes and long-term care facilities?
Older adults living in nursing homes and long-term care facilities will be among the first groups offered a vaccine. However, the exact date will vary state by state.
I am an older adult. If the vaccine is made available to me, should I get it?
I recommend that my older adult patients receive the vaccine. The information we have so far tells us that the vaccines work very well and are safe. Like with any new treatment, there are some things we can’t say with 100 percent certainty. For example, we don’t know if there will be additional side effects that we haven’t seen yet. At the moment, however, we have every reason to think that all people who can get the vaccine, should.
Does the answer to this question change if I live in a nursing home versus somewhere else?
Unfortunately, people who live in nursing homes or long-term care facilities were not included in the studies that have been published so far. The vaccine was found to be safe and effective in older adults living in the community who participated in the clinical trials. Based upon our experience with other vaccines, we do not believe that the risk of side effects for older adults living in nursing homes will be different from those living in the community. Also, based on our experience with other vaccines—particularly vaccines for flu and pneumonia—we do not believe living in a nursing home per se changes the efficacy of the vaccine.
How can I be sure the vaccine is safe for older adults?
All of the vaccines were studied in people over the age of 65. There were no serious issues. As we begin to vaccinate millions of people, we need to watch closely for any side effects that were not seen in clinical trials, and the Centers for Disease Control and Prevention has a comprehensive plan to monitor for vaccine side effects.
What are the most significant side effects to watch out for in older adults?
The most common side effects appear to be arm soreness, tiredness, headache, and a low-grade fever. At the moment, the recommendations are that if you develop a slight fever after the vaccine, use acetaminophen (like Tylenol) to reduce the fever. Rest if you’re tired. If your arm feels sore, you can use heat or ice, like a hot towel or a bag of frozen peas.
Are there any side effects specific to those with health problems or who are taking multiple medications?
We don’t have enough information about this yet. Patients taking multiple medications and who have multiple conditions weren’t included in clinical trials. Based on other vaccines, we don’t expect any additional side effects. But we don’t yet know for sure.
Does it make a difference which vaccine I get?
Most of us won’t get to choose which vaccine we get. My recommendation is to get the first vaccine that you can. To date, we don’t know if one vaccine is more effective than the other as they have not been compared head to head.
What if I do not want to get the vaccine, or if I’m concerned about side effects?
Based on what we know so far, the vaccine appears to be safe with few side effects. We also know that older adults can get very sick from COVID-19, and are more likely to die from the infection. I compare the risk of getting very sick or dying from COVID-19 with what we know about how safe and effective the vaccine is. I would strongly encourage most older adults to get the vaccine.
Are there some older adults who, because of existing medical conditions, should not get the vaccine?
This is something we think about anytime we’re using a new treatment or vaccine. Based on what we know so far, there are no pre-existing medical conditions that should prevent people from receiving the vaccine.
Why are those living in nursing homes or long-term care facilities at greater risk of contracting COVID-19?
One of the most terrifying things about COVID-19 has been the very high death rate among people living in nursing homes and long-term care facilities. There are three reasons for this. The first is that the patients in nursing homes typically have serious or complex medical illness that weakens their immune systems and places them at higher risk of infection. The second is that COVID-19 can spread easily in a closed community like nursing homes. Lastly, many patients living in these facilities have Alzheimer’s disease or a related dementia and may have difficulty recognizing that they are ill or telling someone that they don’t feel well.
What happens if an older adult in a nursing home or long-term care facility is not able to decide whether to get the vaccine, or if they refuse?
In the United States, a person has the right to refuse medical treatment if they are of sound mind. Many residents of nursing homes have dementia and may not be able to understand the risks and benefits of the treatment being offered. If somebody in a nursing home refuses a vaccine, we would first ensure that they have the capacity to make their own medical decisions. Specifically, we ensure that the patient understands the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment).
If they do, then they have the right to refuse a vaccine. If they don’t have the ability to make their own medical decisions, however, we would turn to a designated surrogate decision maker (health care proxy). If the patient has not named a health care proxy, then individual state law determines who would be the decision maker. In most states, this is a family member or next of kin. If there is no next of kin, then we would turn to a court-appointed guardian.