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Dr. Won Lee began her first visit to Almeta Trotter, a new home-bound patient, last month by asking about her life, her health, and how she was managing her life with her longtime partner and a parakeet in her Dorchester neighborhood apartment in Boston. .

Finally, the medical director of the Geriatrics Home Care Program at Boston Medical Center, Dr. Lee raised a key question. “What do you think about the Covid vaccine?” said.

Mrs. Trotter, 77, replied, “I heard I shouldn’t take it because I’m on blood thinners,” due to a heart problem.

Not true. Did Ms. Trotter misunderstand what she heard on the television news or was misinformed, “I told her I had many patients who were in the same condition with the same medication and were vaccinated without any problems,” she said. .

When Ms. Trotter agreed to filming, partly because “the news spoke of all these people dying” and partly because her two daughters had gotten them, Dr. Lee sent a nurse to vaccinate him at home. She is scheduled to take a second dose this month.

The program remains one of 563 home-bound frail patients, most of whom are in their 80s and older, and about 80 remain.

The effort to vaccinate the country’s population over 65 is both a success and a source of intense frustration. It is the age group with the highest rate: 92 percent have had at least one vaccination and 82 percent are fully vaccinated. Yet many remain unprotected.

“Pretty good,” said William Schaffner, an infectious disease specialist at Vanderbilt University. “But we clearly need to do more with this extraordinarily vulnerable population. They are not safe enough.” With the elderly at a much higher risk of serious illness, hospitalization, and death from Covid-19, he had hoped to see vaccination rates above 90 percent so far.

About 10 million elderly people are completely unvaccinated. This not only puts them at risk, but also provides opportunities for the coronavirus to continue to mutate in the bodies of those with compromised immune systems. It can also complicate the planned delivery of third shots.

Last winter, when vaccines became available, the older cohort got off to an advantageous start.

“They were the first in line,” said David Grabowski, a health policy researcher at Harvard Medical School. The elderly are among the priority recipients for appointments, while a federal program has brought vaccination clinics directly into nursing homes. And many were inclined to roll up their sleeves.

Geriatrician who studies infections in older adults at the University of Pittsburgh Medical Center. “Many older adults realize they are at risk,” said David Nace. “We have an older population that is reminiscent of what it was before the polio vaccine or diphtheria vaccine.”

Statistics from the Centers for Disease Control and Prevention He showed that this population’s vaccination rates rose during the spring and then reached a plateau. 80 percent of 65-74 year olds were fully vaccinated on 1 July, gradually reaching almost 84 percent by 1 September. About 76 percent of those over the age of 75 were fully vaccinated on July 1, and now 79 percent.

These figures hide enormous regional differences. Dane County, Wisconsin, which includes Madison, has achieved nearly universal vaccination for people over 65. But in Los Angeles County, only 75 percent are fully vaccinated.

Rates for those over 65 in New York range from 80 percent in Staten Island to just 67 percent in Brooklyn. The rate drops below 50 percent in several Alabama counties and 40 percent in New Mexico extensions.

Even older people who want to shoot can face significant obstacles. Dr. Initially, “some older adults were unable to manage online registration or go to a center,” Grabowski said, when local health authorities operated mass vaccination sites.

Months later, with widely available vaccines, people with disabilities, frailties, or cognitive impairments may still have trouble accessing the first or second shot.

This is especially true for homebound people, who are defined as people who leave their homes once a week or less. According to one study, their numbers increased sharply during the epidemic. Survey at JAMA Internal Medicine published last month.

Among respondents over the age of 70, about five percent went home from 2011 to 2019. In 2020 – possibly due to Covid-related public health recommendations – the rate rose to 13 percent. More than a quarter of them did not have cell phones; half did not have a computer.

However, Dr. Access isn’t the problem for Lee’s patients; In February, nurses and doctors started bringing vaccines to their doorstep. Home medical practices such as UCSF Care at Home in San Francisco and Bloom Healthcare in suburban Denver have also vaccinated their patients. About thousands of programs like this It serves home-bound seniors across the country, according to estimates from the American Academy of Home Care Medicine.

Yet, even after lengthy debate, 14 percent of homebound patients of the Boston Medical Center program either delayed or refused vaccination.

Dr. “The families said, ‘My grandma doesn’t stay out of the house,'” Lee said. “But even if you don’t go out, a family member or caregiver will come in and bring you sickness.” Before the vaccines arrived, his practice had lost 28 patients to Covid, and “that was heartbreaking,” he said.

Dr. As Grabowski said, why dragging the feet will win the most among the population?

The political divide that has driven many Americans to resist vaccination is smaller in the older population than in the younger populations, but still exists. a july Survey by the Kaiser Family Foundation Among those over 65, only three percent of Democrats said they “absolutely won’t” get the vaccine, compared to 13 percent of Republicans.

According to a recent study, where older people get information also plays a role. Study by health care researchers at the University of Iowa, using a national survey of Medicare beneficiaries from late 2020.

According to the survey, at the time when vaccines were not available but imminent, 13 percent of respondents said they would definitely or probably not get vaccinated, primarily due to fear of side effects and distrust of the government. About a quarter were unsure.

“Individuals addicted to social media, the internet, friends, family and healthcare providers were more likely to express a negative vaccination intent compared to those who used ‘regular news’,” said Divya Bhagianadh, co-author of the study. .

Healthcare providers? “There was significant ambivalence among healthcare providers themselves,” said Kanika Arora, co-author of the survey, at the time.

Now, as the country is about to start mobilizing for the third shots, Dr. “I’m concerned about the potential to be free for all,” Grabowski said. “Will the effort to give the booster crowd out people who need a first or second shot? Will there be queues and schedules that make it difficult to vaccinate the elderly?

Vaccination guidelines from employers and schools will not affect most older adults. Continuing efforts will be required by federal and local health authorities to close this particular vaccine gap – including transporting vaccines to individual homes and neighborhood aged centers, providing transportation to pharmacies or clinics, revisiting nursing homes, and ensuring that primary care physicians deliver vaccines in their own hospitals. to ensure. offices.

Miss Trotter, for one, seems pleased to have her injections. He reported that the first dose of the Moderna vaccine caused no side effects.

“My arm didn’t even hurt,” he said.