Expert Shares RSV Vaccination Strategies for Older Adults: Recommendations and Patient Engagement

In an interview with Pharmacy Times®, Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP, clinical professor at the Ernest Mario School of Pharmacy, Rutgers, discussed the risk factors for severe respiratory syncytial virus (RSV) disease in older adults, including chronic lung and cardiovascular conditions, immune compromise, and residence in long-term care facilities. She emphasized the importance of shared clinical decision-making and recommended vaccinating patients in late summer to early fall before RSV spreads. The conversation highlighted strategies for building vaccine confidence, such as using motivational interviewing techniques, expressing empathy, and tailoring communication to patient needs. Bridgeman also suggested proactively identifying eligible patients through medication profiles, electronic health records, and care transition opportunities.

Pharmacy Times: What factors should a health care professional consider when recommending RSV vaccination to an older adult patient?

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP: There are a number of risk factors for severe RSV disease, including having chronic lung diseases like COPD or asthma, having chronic cardiovascular disease like heart failure, being or having immune compromise or hematologic disorders, and and having certain neurologic or endocrine disorders like diabetes. Also, importantly, being a resident of a long-term care facility or a nursing home, as well as those older adults who might be experiencing the frailty syndrome of aging. I think it's really important, especially for the recommendations that talk about shared clinical decision-making and those at an increased risk of severe RSV disease, that the pharmacist be aware and really think about some of those particular risk factors. The last thing I'll conclude on orind you of is that while the RSV vaccine could be administered at any time, I'll point out that really the best time to vaccinate patients is likely in the late summer to early fall, usually before RSV starts to spread in our communities.

Pharmacy Times: What are a few evidence-based strategies a health care professional can use to address an older adult patient's concerns or hesitancy regarding RSV vaccination?

Bridgeman: We learned a lot about vaccine confidence during the COVID-19 pandemic. Really a lot of those principles and things that I think came out related to the way our patients make decisions about health and about immunizations are really applicable in this setting or context of RSV vaccines as well. What are some of the key learnings related to boosting vaccine confidence — listening to our patients and expressing empathy and understanding in our interactions when we're sharing or trying to understand how an individual is making decisions about vaccines. I think also tailoring our messaging and really conveying evidence-based health information. Again, the way that message is being conveyed really matters. These are paramount in building trust and helping our patients make the best-informed decisions possible about their own health. As pharmacists, I think we realize there are a myriad of sources of information that influence our patients’ health decisions, including those decisions around immunization. And really coming into any discussion about vaccines or health-related behaviors with this attitude of collaboration and empathy. You're really there as a partner in your patient's health care team. Leveraging our motivational interviewing techniques is really a way to open up these types of conversations. I usually like to think of the acronym OARS in reminding some of the core skills associated with motivational interviewing. Using those open-ended questions, using affirmations, meaning statements about who the individual is, and affirming their perspective, or what you're hearing them convey. Providing reflection so that you're demonstrating understanding of what an individual is expressing and really summarizing the next steps, reflecting back on the conversation you just had to determine the action. What I hear from our discussion today is that either way, we'll immunize against RSV, or we'll schedule and revisit this conversation at a later time. I do think it's our job as health care professionals to meet our patients where they are in their healthcare journey, to understand their perspectives and information or misinformation that might be coloring their decision, and potentially introduce, in a polite way, information that may help to correct or inform those perspectives. I also try to remember that patients can change their minds at any time in that health care journey, and we need to be able to be there and support them in those decisions when they're ready.

Pharmacy Times: How can health care practices proactively identify older adult patients who are eligible for RSV vaccination based on the updated 2025 CDC guidelines?

Bridgeman: Well, many strategies for identifying indications for immunization exist, especially in the context of RSV vaccines. Recall that these recommendations really include age as well as the presence of medical comorbidities. I think reviewing medication profiles, leveraging our electronic health records and reminders in the ambulatory and community practice settings are one way to identify those who are eligible for the RSV vaccine Care transitions, for example, when someone is entering the long-term care setting, also represent a great opportunity to catch up older adults who might be eligible for receipt of these vaccines if they haven't yet received one dose.