OBJECTIVE: to determine the coverage of influenza vaccination in hospitalized elderly patients in view of the 1998 recommendations of the UK Department of Health, and the reasons for refusal in those unvaccinated. DESIGN: questionnaire-based interview. SETTING: acute elderly-care wards in a district general hospital in South Wales, UK. SUBJECTS: 443 consecutive patients aged over 65 hospitalized during December 1998 and January 1999. RESULTS: of 383 patients in whom influenza vaccination was recommended according to Department of Health guidelines, only 48% received it during the winter of 1998-99. The commonest reason given by those unvaccinated was lack of information from the general practitioner (in 26% of cases). Other reasons were concern about vaccine side effects (21%), perceived good health (16%) and concern about vaccine efficacy (11%). CONCLUSIONS: influenza vaccine uptake in high-risk older hospitalized patients is still unsatisfactory. Improved education of the health-care staff and the general public about the benefits of vaccine is necessary to improve uptake.