Newswise — Flu shots do not work as well in older adults who have recently experienced the death of a family member or close friend, a new study shows.

On the other hand, older adults who are happily married show stronger responses after flu shots than those who are unmarried, especially those who are widowed.

Bereavement and marriage "are the most key factors for older adults, rather than general life-events stress and social support, which have been related to immune response in previous studies of young adults," said lead researcher Anna C. Phillips, Ph.D., of the University of Birmingham in England.

The study appears in the latest issue of Brain, Behavior, and Immunity

Phillips and colleagues studied 184 people (80 men and 104 women) ages 65 years or older who received a single flu shot that offers protection from three strains of influenza. The researchers analyzed antibody response at one month and 12 months after the shot was administered.

The participants completed questionnaires at the beginning of the study and at the one- and 12-month points about life events in the past year such as health, familial and marital relationships, housing, financial situation, and deaths of a spouse, close family members or friends.

"Participants' overall stressful life events exposure was not significantly associated with the antibody response to influenza vaccination," the researchers write. "However, one particular life event, bereavement, was negatively associated with one-month antibody titer."

Forty-five of the participants had suffered bereavement in the year prior to vaccination. At the one-month antibody check they had an average 69 percent lower level of antibodies to one flu strain compared to non-bereaved participants, and an 83 percent lower level of antibodies to another flu strain.

For one of the three flu strains, unmarried participants had a 74 percent lower level of antibodies at the one-month point than married participants who reported marital satisfaction.

A study in the journal Psychosomatic Medicine two years ago by Gregory Miller, Ph.D., of the University of British Columbia found that even modest stress reduces the effect of flu vaccine in the first 10 days following vaccination. Previous research demonstrated the effects of more severe stress on the immune system among older people for longer periods of time.

According to Stewart Neufeld, Ph.D., of the Institute for Gerontology at Wayne State University, "It is possible that bereavement has a negative effect on the immune response due to reduced exercise and poorer eating habits. More physical exercise and better nutrition would be helpful in maintaining a more robust immune system."

However, the Phillips study measured exercise and eating patterns and found they were not associated with antibody response, possibly because the majority of the participants had reasonably healthy habits.

Peter A. Lichtenberg, Ph.D., also of the Institute of Gerontology, said, "Health outcomes are influenced by our biology, our environment, our psychosocial experiences and our health behaviors. This study shows how when one element is severely affected, the health outcome is also affected."

Steps can be taken to improve immune response in the elderly, Phillips said, such as "bereavement counseling, improving how people look after their health at different times through health education, marriage counseling and training to improve marital happiness."


Brain, Behavior, and Immunity: Visit

Phillips A.C., et al. Bereavement and marriage are associated with antibody response to influenza vaccination in the elderly. Brain, Behavior, and Immunity 20(2), 2006.

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Brain, Behavior, and Immunity (20(2), 2006)