4 Reasons Older Adults Are More Likely to Get COVID If They’re Not Vaccinated
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Since COVID first emerged several years ago, one fact has become crystal-clear: Older adults face a much higher risk of severe illness and complications from the virus (SARS-CoV-2).
Why does age make us more vulnerable to serious COVID disease? Let’s look at the factors behind this increased risk—and how vaccination can help older adults stay healthy and out of the hospital.
COVID-19 Risk for Older Adults At a Glance
| Weaker immune system |
As you age, your immune system doesn't respond to infections as effectively, making it harder to fight off COVID-19. |
| More chronic health conditions |
Conditions like heart disease, diabetes, lung disease, kidney disease, and obesity increase the risk of severe COVID-19. |
| Greater exposure in shared living settings |
People living in nursing homes or other long-term care facilities have more opportunities to be exposed to the virus. |
| Age-related inflammation |
Chronic, low-level inflammation that develops with age can worsen COVID-19 symptoms and make recovery more difficult. |
Why does COVID affect older adults more?
There are four primary reasons older Americans are more likely to get infected with COVID and experience worse health outcomes:
| Reason | Why | How Vaccination Helps |
| 1. Weakened immune system | As we age, our natural defenses against infections weaken—a process known as immunosenescence. During this process, the immune system becomes less effective at identifying and fighting off viruses like COVID and building protective immunity. | Vaccination plays a crucial role by strengthening the natural immune response. mRNA vaccines, for example, use special technology to trigger our immune system to produce COVID antibodies, which linger in our body for many months. If we’re exposed to COVID in the future, these antibodies help our immune defenses recognize and attack the virus. Without vaccination, older adults lack this critical boost, leaving their already-compromised immune system at a disadvantage. |
| 2. Greater risk of severe outcomes |
Older adults are more likely to get COVID if they’re unvaccinated, and they’re also at higher risk for severe outcomes like hospitalization and death. Studies have shown the risk of serious complications from COVID increases with age, and older adults continue to bear the largest burden of severe disease. According to the Centers for Disease Control and Prevention (CDC), more than 81% of COVID deaths have occurred in people over 65. The mortality risk in this age group is 97 times higher than that of adults age 18-29.1 The severe impact of COVID on older adults is partly due to the body’s less robust response to infection. However, age-related inflammation in the body (called inflammaging) also plays a role. This long-term inflammation can affect the way SARS-CoV-2 progresses in the body, worsen COVID symptoms, and make recovery from the virus more challenging. Inflammaging also makes us more vulnerable to diseases such as cancer, cardiovascular disease, dementia, and osteoporosis. | The COVID vaccine empowers our immune system to fight off the virus before it can lead to severe complications. For instance, a new study found that the COVID vaccine may help protect the heart. Adults who received the vaccine had a 37.7% lower risk of serious heart-related complications, with the greatest benefit seen in people age 75 and older—their risk was cut by about half.2 Getting vaccinated can also help prevent long COVID, which is when severe and often debilitating COVID symptoms last for weeks and months after the initial infection has passed. Research shows that a person's risk of developing long COVID is lower if they’ve received the vaccine.3 |
| 3. Underlying ongoing health conditions | Many older adults live with chronic health conditions such as heart disease, cancer, chronic lung disease, obesity, diabetes, neurocognitive disorders, and kidney and liver disease. These conditions can further strain an immune system already weakened by age and cause more severe COVID illness. “So, all those comorbidities added to the phenomena of waning immunity as you age leads to you getting an outsized physical manifestation, which is much more severe if you compare it to a younger, healthier individual," Devang Sanghavi, MD, a Florida-based intensivist and medical director, told the American Medical Association. | Vaccination can be especially protective for older adults with chronic conditions, as it lowers the chances of serious complications if they do get COVID. And even when breakthrough cases occur, symptoms tend to be milder than cases in people who are unvaccinated. |
| 4. Higher exposure potential in certain settings | In the early days of the pandemic, nursing home residents made up a large percentage of COVID-related deaths. That’s because in these communal living environments, close contact with others can cause the virus to spread like wildfire. Even with strict safety measures in place, it’s nearly impossible to eliminate exposure risk—especially if some residents aren’t vaccinated. |
Vaccination adds a powerful layer of protection in high-risk residential environments. By getting vaccinated, older adults reduce their risk of getting COVID, even if the virus is circulating in their facility or the broader community. What’s more, vaccinated people are less likely to spread the virus to others—and that helps create a safer environment for everyone, including facility staff and visitors. One new study found that people living with someone who had received a COVID vaccine within the past six months were 43% less likely to test positive than those living with an unvaccinated person who was sick with COVID-19.4 Texas resident Doris Smith, 88, received her COVID vaccine at a community clinic—and she didn’t hesitate to explain why: “I want to be there for my family," she told CBS News Texas. “One time I had the flu and pneumonia at the same time. I had gotten those shots and they helped me." |
Is the latest COVID vaccine safe for seniors?
Yes. The COVID vaccines available today have been rigorously tested for safety through multiple phases of clinical trials. This includes mRNA vaccines, which use well-studied technology to help the body create a strong defense against SARS-CoV-2. After testing and approval, data on vaccines continues to be collected by the FDA and CDC to monitor their safety and effectiveness, including the COVID vaccines.
What are the benefits of mRNA COVID-19 vaccines for older adults?
- Strong protection: Early clinical trials for the two COVID mRNA vaccines showed a more than 90% efficacy rate in preventing infection and high efficacy in preventing severe disease, hospitalization, and death.5 This level of protection can mean the difference between a mild, manageable infection and a life-threatening one.
- Fewer side effects: Older adults can be more sensitive to the side effects of traditional vaccines. Side effects for mRNA vaccines tend to be mild and temporary (e.g., soreness at the injection site or tiredness, and muscle aches).
- Adaptability to different pathogens: As COVID continues to mutate, mRNA technology allows scientists to quickly update the vaccine formula to target new variants—so older adults can stay protected against the latest circulating strains.
Where can I get a free COVID vaccine near me?
Vaccines are typically available at your doctor’s office, community health centers, and local pharmacies (depending on your state). Check your pharmacy’s website to see if appointments are available—some locations may also accept walk-ins.
You can also:
- Dial 211 to connect with essential community services.
- Reach out to organizations that support people who are homebound or provide home health services:
- The Aging Network: 1-800-677-1116
- Eldercare Locator: search by ZIP code at eldercare.acl.gov
- Disability Information and Access Line (DIAL): 1-888-677-1199 or emailing DIAL@n4a.org
- Medicare hotline: 1-800-633-4227 (TTY 1-877-486-2048)
At NCOA, we believe evidence-based vaccines are an important way for older adults to protect themselves and their community. The benefits of vaccination are especially strong for adults 65 and older and for those living with health conditions like heart disease, diabetes, and lung disease.
Dorothea Vafiadis, NCOA Senior Strategist for Healthy Aging, says vaccines are fundamental to staying healthy, independent, and active as we age: “Getting vaccinated can help you stay healthier, avoid serious complications, and maintain an active and independent lifestyle. Have a conversation with your doctor about staying up to date on COVID-19, flu, and RSV vaccines so you have the protection that's right for you.”
The COVID vaccine as well as all ACIP-recommended immunizations for older adults are fully covered by Medicare and Medicaid. That means you should pay nothing out of pocket at your next vaccination appointment.
Set a healthy example for others by talking to your health care provider about getting your COVID and flu shots. You can even get your COVID and flu shots at the same time and be dually protected during cold and flu season.
Frequently asked questions (FAQ)
Am I at high risk for COVID?
You may be at higher risk for severe COVID-19 disease if you:
- Are age 65 or older
- Have a weakened immune system
- Live with chronic conditions (e.g., heart disease, diabetes, lung disease, kidney disease, obesity, or cancer)
- Live in a nursing home or other long-term care facility
How do chronic health conditions increase the risk of severe COVID-19?
Chronic health conditions can increase an older adult's risk of severe COVID-19. Conditions such as heart disease, diabetes, chronic lung disease, obesity, cancer, and kidney disease can make it harder for the body to fight infection.
Should I get a COVID vaccine?
Talk with your doctor or pharmacist about staying up to date on your COVID and other vaccines like flu, RSV, and pneumonia. They can review your medical history and risk factors and help you make an informed decision about protecting your health. NCOA stands behind evidence-based vaccines to help older adults lower their risk of severe disease, hospitalization, and death while protecting the broader community.
When should seniors get vaccinated?
Ask your health care provider or pharmacist about the best time to get vaccinated against COVID-19. The optimal timing depends on your health and risk factors, as well as any recent COVID infections.
Sources
1. Centers for Disease Control and Prevention (CDC). People with Certain Medical Conditions and COVID-19 Risk Factors. Updated June 11, 2025. Found on the internet at https://www.cdc.gov/covid/risk-factors/index.html
2. CIDRAP. Updated COVID vaccines cut risk of hospital care, heart complications, new data reveal. June 22, 2026. Found on the internet at https://www.cidrap.umn.edu/covid-19/updated-covid-vaccines-cut-risk-hospital-care-heart-complications-new-data-reveal
3. Yan Xie, PhD, et. al. Postacute Sequelae of SARS-CoV-2 Infection in the Pre-Delta, Delta, and Omicron Eras. New England Journal of Medicine. July 17, 2024. Found on the internet at https://www.nejm.org/doi/full/10.1056/NEJMoa2403211
4. CIDRAP. COVID vaccination may protect household members. May 15, 2026. Found on the internet at https://www.cidrap.umn.edu/covid-19/covid-vaccination-may-protect-household-members
5. . Yale Medicine. Comparing the COVID-19 Vaccines: How Are They Different? May 20, 2025. Found on the internet at https://www.yalemedicine.org/news/covid-19-vaccine-comparison
Is It Flu or COVID?
While flu and COVID-19 share many similarities, they are distinct illnesses with different causes, complications, and treatments.
