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Influenza is the infectious disease with the highest population-based mortality. It mainly affects those aged 60 years and older, mainly due to immune senescence, which also favors complicated courses and compromises vaccine effectiveness. Therefore, various approaches have been developed for more immunogenic vaccines, which are now available for use. The Ständige Impfkommission (STIKO) has taken this into account in its current recommendation on influenza vaccination and has recommended a quadrivalent, inactivated high-dose vaccine as the standard vaccine for all ≥ 60-year-olds. Despite these successes, vaccination for prevention remains underutilized. Germany has never reached the WHO vaccination target of 75% of the elderly population. The main reasons for this are a lack of confidence in the effectiveness of vaccination, a lack of/restricted risk perception of the disease, and barriers to implementation. Initial approaches to overcoming these barriers, such as low-threshold vaccination services by involving pharmacies, are being implemented. However, further steps are needed to realize the potential of influenza vaccination, especially for such vulnerable groups as older adults.Die Influenza ist die Infektionskrankheit mit der höchsten bevölkerungsbezogenen Mortalität. Diese trifft vor allem die über 60-Jährigen, bedingt durch die Immunseneszenz, die auch komplizierte Verläufe begünstigt und die Wirksamkeit der Impfung beeinträchtigt. Daher wurden verschiedene Ansätze zur Entwicklung stärker immunogener Vakzine verfolgt und erfolgreich umgesetzt. Dies hat die Ständige Impfkommission (STIKO) in ihrer aktuellen Empfehlung zur Grippeimpfung berücksichtigt und einen quadrivalenten, inaktivierten Hochdosisimpfstoff als Standard für alle über 60-Jährigen empfohlen. Trotz dieser Erfolge wird die Impfung zur Prävention nach wie vor unzureichend genutzt. Deutschland hat das WHO-Impfziel von 75 % der älteren Bevölkerung bisher nie erreicht. Gründe dafür sind vor allem fehlendes Vertrauen in die Wirksamkeit der Impfung, die fehlende/eingeschränkte Risikowahrnehmung der Erkrankung und Barrieren für die Umsetzung. Erste Ansätze zur Überwindung der Barrieren, wie niederschwellige Impfangebote durch Einbezug von Apotheken, werden umgesetzt. Weitergehende Schritte sind jedoch erforderlich, um das Potenzial der Influenzaimpfung insbesondere für vulnerable Gruppen wie die der Älteren auszuschöpfen.

Immunosenescence leads to an increasing susceptibility to infections. Therefore, vaccination is an essential element of prevention. The recommendations of the permanent vaccination commission (STIKO), a committee at the Robert-Koch-Institute, affiliated to the German Government, are updated every year and include a particular section dealing with older adults.Immunosenescence reduces vaccine effectiveness. Thus, older adults and patients with multimorbidity are in need of more immunogenic vaccines. Cell culture derived quadrivalent influenza vaccine, trivalent adjuvanted vaccine and a high dose influenza vaccine show higher immune response in these groups. STIKO actually recommends an adjuvanted herpes zoster subunit vaccine to all adults in the age of 60 and above because of its vaccine effectiveness of 90 % in all age groups. The increasing travel activities of older adults require travel vaccination advice that takes into account travel destination as well as multimorbidity. Adjusted vaccination schedules and controlling of antibody titers have to be considered.New vaccines are under development, that are more immunogenic and therefore more effective (e. g. pneumococcal vaccine) or that prevent infections for which a vaccine was previously not available (e. g. norovirus vaccine).Die Wirksamkeit von Impfungen ist durch die Immunseneszenz reduziert. Stärker immunogene Impfstoffe sind daher für Hochbetagte und Multimorbide von besonderer Bedeutung. · Influenzaimpfung: Für die Influenzaimpfung stehen mittlerweile quadrivalente zellkulturbasierte, trivalente adjuvantierte und hochdosierte Impfstoffe zur Verfügung, die zu einer besseren Wirksamkeit führen.. · Herpes-Zoster-Impfung: Die aktuell von der STIKO empfohlene Herpes-Zoster-Vakzine ist ein adjuvantierter Totimpfstoff, der eine Wirksamkeit von über 90 % erzielt. Diese Impfung ist als Standard für alle 60-Jährigen und Älteren empfohlen.. · Reiseimpfungen: Aufgrund der zunehmenden Reisetätigkeit von Senioren ist eine Impfberatung wichtig, die neben dem Reiseziel vor allem auch die Multimorbidität berücksichtigt. Dabei sind ggf. geänderte Impfschemata zu beachten..Die in der Entwicklung befindlichen Impfstoffe – Pneumokokken-, Norovirus-, Clostridium-difficile-, Hepatitis-B-Vakzine – betreffen zum einen Erkrankungen, für die bisher keine Impfungen für Senioren zur Verfügung stehen (z. B. Norovirus-Infektion), zum anderen werden stärker immunogene Vakzine mit einer breiteren Wirksamkeit entwickelt (z. B. Pneumokokken-Vakzine).

Alte und multimorbide Patienten sind besonders vulnerabel für einen schweren Verlauf von COVID-19. Die Maßnahmen zur Eindämmung der Pandemie und die Anpassung der Versorgungsstrukturen wirken sich massiv auf die ambulante geriatrische und die Notfallversorgung aus, sowie auf den akutstationären Bereich bis hin zu geriatrischer Rehabilitation und stationärer Pflege.

The current corona crisis affects older patients as well as the geriatric infrastructure in all sectors. This article provides an overview about the current state of knowledge on COVID-19 with special consideration of geriatric aspects and the consequences for the geriatric care system.

In Germany up to 20% of the population are affected by influenza every year. Particularly for the elderly, influenza is related to high morbidity and mortality and 90% of deaths are related to the group of 60 years and older. In this context, seasonal influenza caused by influenza A (H3N2) viruses is exceedingly relevant for the elderly. The aging of the immune system, immunosenescence, is well documented as the cause of increased susceptibility to infection and change of typical symptoms. This can cause a delay in diagnosing and treatment of influenza infections. Furthermore, immunosenescence can lead to decreased efficacy of vaccination. Adjuvanted vaccines and vaccines with higher antigen content cause an enhanced immune response and are therefore especially suitable for prevention. The Standing Vaccination Committee (STIKO) recommends vaccination against seasonal influenza for all persons 60 years of age and over as well as for nursing home residents, pregnant women and chronically ill patients. For the coming influenza season 2018/19, the STIKO generally recommends the administration of quadrivalent (tetravalent) vaccines for the first time.

Infectious diseases are responsible for up to 5% of fatalities even in developed countries. In addition, there is an increasing susceptibility for infections in elderly people due to physiological aging of the immune system. The principles of vaccination are based on a targeted activation of the human immune system. Principally, a distinction is made between passive immunization, i.e. the application of specific antibodies against a pathogen and active immunization. In active immunization, i.e. vaccination, weakened (attenuated) or dead pathogens or components of pathogens (antigens) are administered. After a latency period that depends on the vaccine, complete immune protection is achieved and immunity is maintained for a certain period of time. In contrast to dead vaccines, by the use of live vaccines there is always a risk for infection with the administered vaccine. In passive immunization antibodies are administered. As a rule passive immunization is carried out in persons who have had contact with an infected person and in whom no or uncertain immunity against the corresponding disease is present. Based on the recommendations of the Standing Committee on Vaccination (STIKO), influenza, pneumococcal, herpes zoster, early summer meningoencephalitis (FSME) and travel vaccines are described.

Nursing home residents and older hospitalized patients have a significantly higher risk to suffer from nosocomial infections (NI). It is still an unanswered question whether patients suffering from NI are at greater risk for deterioration of activities of daily living.In a retrospective observational study, we evaluated the prevalence of NI during hospitalization of acute geriatric inpatients of the geriatric department at Jena University Hospital by patient records. The study included data from 555 patients, hospitalized from 1 August 2011 to 31 August 2012. We included patients without acute complications and those who developed NI after the second day of hospitalization.Every third patient developed a NI during the observation period. Consequently, the incidence of NI was approximately 18 patients with NI per 1000 days of hospitalization. This rate was considerably higher than the national average. The most frequent NIs were urinary tract infection, gastroenteritis and infections of the lower respiratory tract. A low value of Barthel index at admission, high multimorbidity index and transurethral indwelling catheters promoted the development of NI. An improvement in activities of daily living, assessed by mean values of the difference in the Barthel index, was significantly lower in patients who developed NI (mean value14.5 ± 16.3) than in patients who did not (mean value 18.1 ± 14.8).Nosocomial infections were a relevant factor for deterioration of the Barthel Index, at least temporarily and NIs, in particular the combination of several NIs, jeopardized an improvement in the activities of daily living. This was particularly true for infections of the lower respiratory tract and gastroenteritis.

Aging of the immune system, so-called immunosenescence, is well documented as the cause of increased infection rates and severe, often complicated courses of infections in older adults. This is particularly true for pneumococcal pneumonia in older adults; therefore, the standing committee on vaccination of the Robert Koch Institute (STIKO) recommends a once only vaccination with 23-valent pneumococcal polysaccharide vaccine for all persons aged 60 years and over. Furthermore, the 13-valent pneumococcal conjugate vaccine is also available for administration in adults and is recommended by the STIKO for particular indications. The advantage of the pneumococcal conjugate vaccine is the additional induction of a T-cell dependent immune response that leads to good immunogenicity despite immunosenescence. Initial data from a recent randomized controlled trial, so far only presented at conferences, confirm that the conjugate vaccine also provides protection against non-bacteremic pneumococcal pneumonia, which is not provided by the polysaccharide vaccine. Thus, there are two vaccines for prevention of pneumococcal diseases: one with a broader range of serotype coverage but with an uncertain protection against non-bacteremic pneumococcal pneumonia and another one with less serotype coverage but more effective protection. Vaccination of children with the conjugate vaccine also leads to a rapid decrease of infections by the 13 vaccine serotypes even in adults because of herd protection effects. For prevention of pneumonia in older adults the additional benefit of a concurrent application of influenza vaccine and pneumococcal vaccine should be considered.