{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:34:09Z","timestamp":1792020849875,"version":"4.4.0"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T00:00:00Z","timestamp":1648944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>It is known that influenza, herpes zoster, pneumococcal and pertussis infections may increase morbidity and mortality in older people. Vaccinations against these pathogens are effective in older adults. Frailty seems to be an important determinant of vaccination rates, yet data supporting this association are still missing. Therefore, we aimed to investigate the prevalence of four recommended vaccinations (influenza, herpes zoster, pneumococcal and diphtheria-tetanus-pertussis) and the association with multidimensional frailty assessed using a self-reported comprehensive geriatric assessment tool, i.e., the multidimensional prognostic index (SELFY-MPI). Older participants visiting the outpatient clinic of Azienda Ospedaliera Universitaria, Palermo, Italy were included. The SELFY-MPI questionnaire score was calculated based on eight different domains, while the vaccination status was determined using self-reported information. We included 319 participants from the 500 initially considered (63.8%). Vaccination against influenza was observed in 70.5% of the cases, whilst only 1.3% received the vaccination against diphtheria-tetanus-pertussis. Participants with higher SELFY-MPI scores were more likely to report vaccination against pneumococcus (45.6 vs. 28.3%, p = 0.01), whilst no significant differences were observed for the other vaccinations. In conclusion, the coverage of recommended vaccinations is low. Higher SELFY-MPI scores and vaccination status, particularly anti-pneumococcus, appear to be associated, but future studies are urgently needed for confirming that frailty is associated with vaccination status in older people.<\/jats:p>","DOI":"10.3390\/vaccines10040555","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T05:50:43Z","timestamp":1649051443000},"page":"555","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Multidimensional Frailty and Vaccinations in Older People: A Cross-Sectional Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9328-289X","authenticated-orcid":false,"given":"Nicola","family":"Veronese","sequence":"first","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusy","family":"Vassallo","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Armata","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Cilona","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Casalicchio","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Masnata","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-7331","authenticated-orcid":false,"given":"Claudio","family":"Costantino","sequence":"additional","affiliation":[{"name":"Hygiene Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Vitale","sequence":"additional","affiliation":[{"name":"Hygiene Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-6289","authenticated-orcid":false,"given":"Giovanni Maurizio","family":"Giammanco","sequence":"additional","affiliation":[{"name":"Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0453-8663","authenticated-orcid":false,"given":"Stefania","family":"Maggi","sequence":"additional","affiliation":[{"name":"Consiglio Nazionale delle Ricerche, Neuroscience Institute, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-2350","authenticated-orcid":false,"given":"Shaun","family":"Sabico","sequence":"additional","affiliation":[{"name":"Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5472-1725","authenticated-orcid":false,"given":"Nasser M.","family":"Al-Daghri","sequence":"additional","affiliation":[{"name":"Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligia J.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"},{"name":"Faculty of Medicine and Surgery, University of Enna \u201cKore\u201d, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1349-6530","authenticated-orcid":false,"given":"Mario","family":"Barbagallo","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.7326\/0003-4819-98-3-395","article-title":"Infectious diseases in the elderly","volume":"98","author":"Schneider","year":"1983","journal-title":"Ann. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"n188","DOI":"10.1136\/bmj.n188","article-title":"Vaccines for older adults","volume":"372","author":"Cunningham","year":"2021","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Montalti, M., Di Valerio, Z., Rallo, F., Squillace, L., Costantino, C., Tomasello, F., Mauro, G.L., Stillo, M., Perrone, P., and Resi, D. (2021). Attitudes toward the SARS-CoV-2 and Influenza Vaccination in the Metropolitan Cities of Bologna and Palermo, Italy. Vaccines, 9.","DOI":"10.3390\/vaccines9101200"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jamda.2015.06.025","article-title":"Prevalence of frailty in nursing homes: A systematic review and meta-analysis","volume":"16","author":"Kojima","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/ageing\/afaa219","article-title":"Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies","volume":"50","author":"Sezgin","year":"2021","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101498","DOI":"10.1016\/j.arr.2021.101498","article-title":"Prevalence of multidimensional frailty and pre-frailty in older people in different settings: A systematic review and meta-analysis","volume":"72","author":"Veronese","year":"2021","journal-title":"Ageing Res. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.eurger.2010.01.010","article-title":"Immunological pathogenesis of main age-related diseases and frailty: Role of immunosenescence","volume":"1","author":"Lang","year":"2010","journal-title":"Eur. Geriatr. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101351","DOI":"10.1016\/j.arr.2021.101351","article-title":"Fostering healthy aging: The interdependency of infections, immunity and frailty","volume":"69","author":"Vetrano","year":"2021","journal-title":"Ageing Res. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4081\/gc.2019.8502","article-title":"Implementation of the SELFY-MPI in five European Countries: A multicenter international feasibility study","volume":"5","author":"Zora","year":"2019","journal-title":"Geriatr. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"493","DOI":"10.2147\/CIA.S241721","article-title":"Agreement of a short form of the self-administered multidimensional prognostic index (SELFY-MPI-SF): A useful tool for the self-assessment of frailty in community-dwelling older people","volume":"15","author":"Cella","year":"2020","journal-title":"Clin. Interv. Aging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1089\/rej.2018.2103","article-title":"Development and validation of a self-administered multidimensional prognostic index to predict negative health outcomes in community-dwelling persons","volume":"22","author":"Pilotto","year":"2019","journal-title":"Rejuvenation Res."},{"key":"ref_13","first-page":"61","article-title":"Functional evaluation: The Barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: Self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1136\/bmj.b2030","article-title":"Self administered cognitive screening test (TYM) for detection of Alzheimer\u2019s disease: Cross sectional study","volume":"338","author":"Brown","year":"2009","journal-title":"BMJ"},{"key":"ref_16","first-page":"145","article-title":"Self-administered function measures: The impossible dream","volume":"28","author":"Goeppinger","year":"1985","journal-title":"Arthritis Rheum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1007\/s12603-009-0214-7","article-title":"Validation of the Mini Nutritional Assessment Short-Form (MNA\u00ae-SF): A practical tool for identification of nutritional status","volume":"13","author":"Kaiser","year":"2009","journal-title":"JNHA J. Nutr. Health Aging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s12603-017-0919-y","article-title":"Validity of the self-mini nutritional assessment (Self-MNA) for the evaluation of nutritional risk. A cross-sectional study conducted in general practice","volume":"22","author":"Donini","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/j.1532-5415.1968.tb02103.x","article-title":"Cumulative illness rating scale","volume":"16","author":"Linn","year":"1968","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1089\/rej.2007.0569","article-title":"Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients","volume":"11","author":"Pilotto","year":"2008","journal-title":"Rejuvenation Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101047","DOI":"10.1016\/j.arr.2020.101047","article-title":"A multidimensional approach to frailty in older people","volume":"60","author":"Pilotto","year":"2020","journal-title":"Ageing Res. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/21645515.2021.1971473","article-title":"Recommendations of the Italian society for infectious and tropical diseases (SIMIT) for adult vaccinations","volume":"17","author":"Andreoni","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pilotto, A., Maggi, S., Ferrari, A., Rengo, G., Solfrizzi, V., Zora, S., Brignoli, O., Aprile, P.L., Fascella, G., and Dominguez, L.J. (2022). Multidimensional frailty in older people in general practitioners\u2019 clinical practice: The SELFY-MPI SIGOT project. Geriatr. Care, 8.","DOI":"10.4081\/gc.2022.10388"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/biomet\/41.1-2.133","article-title":"A distribution-free k-sample test against ordered alternatives","volume":"41","author":"Jonckheere","year":"1954","journal-title":"Biometrika"},{"key":"ref_25","unstructured":"Indicators, O. (2019). Health at a Glance 2019: OECD Indicators, OECD Publishing."},{"key":"ref_26","first-page":"E10","article-title":"COVID-19 emergency in Sicily and intersection with the 2019-2020 influenza epidemic","volume":"62","author":"Tramuto","year":"2021","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Domnich, A., Cambiaggi, M., Vasco, A., Maraniello, L., Ansaldi, F., Baldo, V., Bonanni, P., Calabr\u00f2, G.E., Costantino, C., and de Waure, C. (2020). Attitudes and beliefs on influenza vaccination during the COVID-19 pandemic: Results from a representative Italian survey. Vaccines, 8.","DOI":"10.3390\/vaccines8040711"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1017\/S0950268820001077","article-title":"Impact of vaccination on invasive pneumococcal disease in Italy 2007\u20132017: Surveillance challenges and epidemiological changes","volume":"148","author":"Monali","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41479-017-0045-y","article-title":"Pneumococcal vaccination in older persons: Where are we today?","volume":"10","author":"Booy","year":"2018","journal-title":"Pneumonia"},{"key":"ref_30","first-page":"453","article-title":"Pneumonia immunization in older adults: Review of vaccine effectiveness and strategies","volume":"7","author":"Assaad","year":"2012","journal-title":"Clin. Interv. Aging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5459793","DOI":"10.1155\/2020\/5459793","article-title":"Vaccination coverage of the elderly in greece: A cross-sectional nationwide study","volume":"2020","author":"Papagiannis","year":"2020","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1086\/320169","article-title":"Herpes zoster in older adults","volume":"32","author":"Schmader","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1001\/archinte.1995.00430150071008","article-title":"The incidence of herpes zoster","volume":"155","author":"Donahue","year":"1995","journal-title":"Arch. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gagliardi, A.M.Z., Andriolo, B.N.G., Torloni, M.R., Soares, B.G.O., de Oliveira Gomes, J., Andriolo, R.B., and Canteiro Cruz, E. (2019). Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD008858.pub4"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/S0140-6736(21)00984-3","article-title":"Measuring routine childhood vaccination coverage in 204 countries and territories, 1980\u20132019: A systematic analysis for the Global Burden of Disease Study 2020, Release 1","volume":"398","author":"Galles","year":"2021","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40520-021-02018-3","article-title":"Improving vaccination rates in older adults and at-risk groups: Focus on pertussis","volume":"34","author":"Choi","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_37","unstructured":"Norris, T., Vahratian, A., and Cohen, R.A. (2017). Vaccination Coverage among Adults Aged 65 and Over: United States, 2015."},{"key":"ref_38","unstructured":"Royal Society For Public Health (2019). Moving the Needle: Promoting Vaccination Uptake across the Life Course, Royal Society For Public Health."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.vaccine.2013.12.012","article-title":"Tetanus in Italy 2001\u20132010: A continuing threat in older adults","volume":"32","author":"Filia","year":"2014","journal-title":"Vaccine"},{"key":"ref_40","first-page":"1669","article-title":"A comparison between uni-and multidimensional frailty measures: Prevalence, functional status, and relationships with disability","volume":"10","author":"Roppolo","year":"2015","journal-title":"Clin. Interv. Aging"},{"key":"ref_41","first-page":"734636","article-title":"\u2018Ageism\u2019Is Associated with Multidimensional Frailty in Community-dwelling Older Subjects: A Population-based Study","volume":"8","author":"Pilotto","year":"2021","journal-title":"Front. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1183\/09031936.00199810","article-title":"Community-acquired pneumonia as an emergency: Time for an aggressive intervention to lower mortality","volume":"38","author":"Ewig","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1093\/geroni\/igab046.2403","article-title":"Standardized Self-Report Tools in Geriatric Medicine Practice: A Quality Improvement Study","volume":"5","author":"Northwood","year":"2021","journal-title":"Innov. Aging"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/4\/555\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:49:28Z","timestamp":1760136568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/4\/555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,3]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["vaccines10040555"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10040555","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,3]]}}}