Self-perceptions of aging mediate the association between illness perception and influenza vaccine hesitancy in older adults with pneumonia during the 2024–2025 influenza season

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Background: As population aging accelerates, pneumonia cases in older adults continue to rise. Although vaccination effectively prevents influenza and reduces secondary pneumonia risk, hesitancy persists in this demographic. Previous studies have explored the link between illness perception and vaccine hesitancy, but the role of self-perceptions of aging in their relationship remains unclear. Methods: A cross-sectional study was conducted. From November 2024 to March 2025, 321 older pneumonia inpatients were recruited from a hospital in China. Data on illness perception, self-perceptions of aging, and influenza vaccine hesitancy were collected using the Brief Illness Perception Questionnaire, the brief version of the Attitudes to Aging Questionnaire, and the Influenza Vaccine Hesitancy Scale for individuals aged 60 years and above. Bootstrap sampling (replicates 5,000) was used to examine the mediating role of self-perceptions of aging. Results: < 0.01). After controlling for covariates, an indirect association through self-perceptions of aging was observed in the relationship between illness perception and influenza vaccine hesitancy, accounting for 35.36% (95% CI: 22.56-51.39%) of the total association. Conclusion: This study highlights the importance of self-perceptions of aging toward vaccine take-up among older pneumonia patients. Interventions targeting attitudes toward aging may represent new strategies for increasing influenza vaccination rates.

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