BACKGROUND Invasive pneumococcal disease is a major cause of morbidity and mortality in elderly patients. This study investigated the impact of a patient education intervention on the pneumococcal vaccination rate in elders. METHODS Charts of all patients aged 65 years or older who visited a university ambulatory care clinic during a 3-month period were reviewed for pneumococcal vaccination status before the patients' arrival for an office visit. Those who did not have the vaccination were provided patient education in the waiting room. Data were collected on age, sex, race, and immunization status. The reasons for refusing the vaccination before or during this intervention also were obtained. The charts of patients who consented were flagged for the attending physician to order the vaccination if appropriate. RESULTS Charts of 535 patients were reviewed for pneumococcal vaccination status. Of these patients, 291 had had a pneumococcal vaccination before the study. The cumulative vaccination rate increased significantly from 54 percent to 79 percent after the study intervention. The rate of pneumococcal vaccination was significantly lower among African-Americans than whites both before and after the patient education intervention. CONCLUSIONS This study reports a substantial impact of patient education on improving pneumococcal vaccination rates in an elderly population. Most elders accept vaccination, and it can be delivered effectively without an additional visit.