Dear Dr. Roach: Whenever I go to my local VA clinic for a checkup, I’m asked if I want the pneumonia vaccine. I’m 70, and I wonder if that vaccine has proven to be beneficial. Thank you.
L.B.
There are two pneumonia vaccines. One is the 23-valent pneumococcal polysaccharide vaccine, often called by its brand name, Pneumovax. The evidence that it is beneficial is strong. It reduced the most serious type of invasive disease (such as meningitis) by 75% and of less serious, but still important, disease (such as pneumonia) by more than 50%. This vaccine should be given at age 65 to otherwise healthy people, but also to younger people with certain medical conditions, including people with most chronic heart and lung problems.
The second type of pneumonia vaccine is the 13-valent pneumococcal conjugate vaccine, Prevnar. It is also effective, and against some different strains from those covered by the 23-valent vaccine. It was also shown to reduce infections caused by the bacteria Streptococcus pneumoniae by 50% to 75%. However, because the PCV13 vaccine has been given to children since 2014, the rate of disease caused by strains that are covered by the vaccine has dramatically decreased in adults. A repeat study was unable to show a benefit now that there is so much less invasive pneumococcal disease in adults. For this reason, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention has changed its recommendation. It is now left up to the physician and patient to decide whether to give the vaccine. In general, I still recommend it, as there is very low risk in giving the vaccine.
If you plan to get both vaccines, get the PCV13 first, followed by the PPSV23. That can be as soon as eight weeks for high-risk patients, but wait a year in between for average-risk patients.
Dear Dr. Roach: I’m 63 and in great health and shape. I work out daily, be it weights, running, hiking or cycling. I’m 5 feet, 10 inches tall and weigh 165 pounds. I have terrible balance. Added to that, I have postural hypotension. Combine the two and a fall seems to be destined in my very near future. Advice?
M.T.
It’s great that you are in such good shape, but a fall can be a devastating event for even a healthy person in their 60s. It is much more likely to be so in people who are older and frailer.
From a balance standpoint, I recommend you add in specific balance exercises. Although balance is certainly needed for the activities you do, an activity like tai chi has been proven to reduce the risk of falls. Even enthusiastic athletes like yourself can improve with the slow and controlled movements of tai chi, which train excellent balance.
Postural hypotension is when the blood pressure goes down upon change of position, especially from laying to sitting or standing. General advice includes taking extra time after changing positions to allow your body to get used to the new position — jumping out of bed and zooming down the hall is no longer a good idea for you. Also, making sure you are getting enough fluids can help keep the blood pressure from going too low. Ask your doctor about salt intake, as some people with symptomatic postural hypotension need extra salt, but I can’t give that advice without knowing a lot more about you.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
