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Associations of frailty with immune response to influenza vaccine in adults 50 years of age and older and interrelationships among frailty, quality of life indicators and spirituality

Moehling, Krissy (2018) Associations of frailty with immune response to influenza vaccine in adults 50 years of age and older and interrelationships among frailty, quality of life indicators and spirituality. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: Physical frailty, the multi-dimensional syndrome characterized by diminished strength, endurance, and reduced physiologic function is increasingly prevalent with advancing age. Frailty leads to increased risk of acute illness, falls, disability, hospitalization, institutionalization and mortality. The negative impact of frailty on the immune system is beyond that of aging-related changes alone. Frailty is also associated with psychosocial aspects of quality of life such as depression and stress. Methods: This three-paper dissertation examined the effects of physical frailty in adults ≥ 50 years of age on both immunological response to influenza vaccine (papers 1 and 2) and psychosocial factors (paper 3). Results: Paper 1: Frailty exists in community-dwelling adults < 65 years of age and the relationship to influenza vaccine immune response in frail younger adults differs from frail adults ≥ 65. In adults 50-64 years of age, frailty appeared to be protective in eliciting beneficial immune system response to influenza vaccine. Paper 2: Among long-term care residents ≥ 65 years, there was a differential effect of frailty on immune response to influenza vaccine by vaccine type. Frail long-term care residents, as compared to non-frail, showed overall greater odds of obtaining influenza vaccine immunogenicity protection outcomes by the high dose vaccine group than those in the standard dose group. Paper 3: Among community-dwelling adults ≥ 50 years, the relationship between quality of life measures and frailty was moderated by spirituality. The effect of quality of life upon frailty varied by the level of spirituality; as spirituality decreased, quality of life became more important. Conclusion: There have been few studies that have specifically measured the influence of physical frailty on immune system response to influenza vaccination. Only one prior study has examined the role spirituality had in moderating the quality of life-frailty relationship. With an increasingly aging population and the costs associated with increased healthcare utilization, it is important to address the immunological and psychosocial aspects of health affected by physical frailty. This dissertation addresses both aspects. Public Health Significance: All three studies are among the first of their kind thereby adding to the literature. Important findings have emerged from this dissertation and steps are given for future research direction.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Moehling, Krissykkm17@pitt.edukkm17
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBertolet,
Committee MemberZimmerman,
Committee MemberNowalk, Mary
Committee MemberBromberger,
Committee MemberAlbert,
Date: 28 June 2018
Date Type: Publication
Defense Date: 28 November 2017
Approval Date: 28 June 2018
Submission Date: 26 November 2017
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 186
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: influenza, HAI, immune response, quality of life, spirituality
Date Deposited: 28 Jun 2018 20:40
Last Modified: 01 May 2020 05:15


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