BACKGROUND:
Nursing home residents are at higher risk of influenza-associated death than the non-institutionalized elderly because of advanced age and chronic conditions. A better understanding of the association between vaccination and factors that increase risk of influenza-related death within the institutionalized population would contribute to interpretation of national trends in influenza-related deaths.

OBJECTIVE:
Facility- and individual-level factors potentially associated with influenza vaccination in institutionalized elderly were explored using data combined from three years of the National Nursing Home Survey (1995, 1997, 1999).

METHOD:
Bivariate analysis identified factors significantly associated with influenza vaccination in the year before each survey. These variables were entered into a multivariable logistic regression model.

RESULT:
Reported vaccine coverage was 79% among residents with a length of stay of ³12 months. Factors significantly associated with vaccination included: presence of an influenza vaccination program; nursing home length of stay >4 years; intermediate/skilled care; bladder and bowel incontinence; previously residing in nursing home or private residence; and no history of stroke. These effects were of small magnitude.

CONCLUSION:
Although the influenza vaccination rate of 79% fell short of the Healthy People 2010 Objective of 90%, it is higher than previous estimates due to exclusion of those not resident during the influenza vaccination period. Programs implementing standing orders are likely to raise rates. Vaccination did not appear to be associated with factors that increase risk of influenza-related death within the institutionalized population, but nursing home residents are more likely vaccinated than community-dwelling elderly (79% vs. 62%).

LEARNING OBJECTIVES:
Be aware that institutionalized elderly did not appear to be vaccinated against influenza differentially by age or underlying disease. Understand that estimates of vaccine coverage in nursing homes are higher when restricted to residents present during the influenza vaccination period. Realize that implementation of standing orders and other efforts to increase vaccination coverage among nursing home residents are needed.