Seasonal influenza is associated with signiï¬?cant morbidity and mortality among older adults, aged 65 and older. Since vaccination is the single most effective preventive measure against seasonal influenza, clinicians and senior citizen center administrators need a better understanding of the perceptions of older adults concerning the reason for poor influenza vaccine uptake. The purpose of this study was to identify perceived factors that may be associated with poor influenza vaccination uptake among older adults. The health belief model (HBM) guided the study. The research questions examined perceptions predicting the odds of influenza vaccination uptake among older adults. This quantitative cross-sectional study consisted of administration of a newly developed 33-item questionnaire to a convenience sample of 147 older adult participants. A 2-week reliability test-retest on 50 participants indicated the instrument had moderate internal consistency (α -?¥ 0.7). Paired-sample t tests were not significant (p > .05), indicating that participants provided reliable responses across time. Ordinal regression analysis indicated that all HBM constructs were significantly associated (susceptibility, barriers, benefits, cues to action, and self-efficacy p = .000; severity p = .002) with frequency of influenza disease and recency of influenza vaccine uptake within 1 year. The social change implications from this study may help to improve vaccination uptake among older adults by providing senior public health decision makers and direct care clinicians with informed knowledge on perceptions and barriers that may play a role in influenza vaccination decision-making among older adults.