Vaccination choices for older people, looking beyond age specific approaches.

INTRODUCTION: To improve the ability of vaccines to protect older individuals we can no longer consider those over 65 years of age to be an homogenous population termed the 'elderly' displaying a condition termed immunosenescence. AREAS COVERED: The most recent figures from the US Census Bureau indicate that the global population exceeds 7,400 million. Of these more than 657 million are currently over 65, an age often designated by policy makers as permitting them access to concessions, pensions and social care benefits. But the spill-over consequences of these policies are the impact they have on access to different vaccine formulations. Aging is associated with a blunted immune system, often termed immunosenescence, and because those of 65 are considered old, by association they are thought to have reduced immunity. Consequently, different vaccines are offered to those over this age. EXPERT COMMENTARY: We believe it to be an inappropriate policy to ascribe a biological condition and consequent vaccine choices, to a population on the basis of single chronological feature. To ensure better protection within this population we need to consider approaches to stratify this group to ensure the best vaccine choices.