Clinical research study
Preventive Health Care among Older Women: Missed Opportunities and Poor Targeting

This paper was presented in part at the National Meeting of the American Geriatrics Society, Seattle, Washington, May 4, 2007.
https://doi.org/10.1016/j.amjmed.2008.05.042Get rights and content

Abstract

Background

Experts recommend that clinicians target mammography and colon cancer screening to individuals with at least 5 years life expectancy. Generally, immunizations and exercise counseling are recommended for all women aged ≥65 years, while Pap smears are generally not encouraged for these women.

Methods

We used the 2005 National Health Interview Survey to examine receipt of several preventive health measures simultaneously among community dwelling US women aged ≥65 years by age and health status. We used functional status, significant diseases, and perceived health to categorize women into those most likely to be in above-average, average, or below-average health status. We used age and health status to estimate life expectancy.

Results

Of 4683 participants, 25.8% were ≥80 years; 81.8% were non-Hispanic white; 21% were in above-average and 20% were in below-average health status. Receipt of mammography and colon cancer screening decreased with age and was not associated with health status for women aged ≥80 years. Nearly half (49%) of women aged ≥80 years in below-average health received mammography screening, while 19% of women aged 65-79 years in above-average health did not report receiving mammography. Nearly half of women aged 65-79 years (49%) in above-average health did not report receiving colon cancer screening. Pap smear screening was common among older women. Few (34%) reported receiving exercise counseling. Many did not report receiving pneumococcal (43%) or flu vaccinations (40%).

Conclusions

In our comprehensive review of preventive health measures for older women, we found evidence to suggest a need to improve delivery and targeting of preventive health services.

Section snippets

Data Source

We used the 2005 National Health Interview Survey (NHIS), a continuing, in-person household survey of the civilian, non-institutionalized US population, conducted by the Census Bureau for the National Center for Health Statistics.12 The NHIS collects information from a nationally representative sample including sociodemographic factors, functional status, insurance coverage, and access to health care for all household members. One randomly selected adult from each responding family is asked to

Results

Of the 4683 women in our study, 30.3% were aged 65-69 years, 23.9% were aged 70-74 years, 20.0% were aged 75-79 years, 15.6% were aged 80-84 years, and 10.2% were aged 85 years or older; the majority (81.8%) were non-Hispanic white. Ten percent had only seen their clinician once within the past year and this varied slightly by age (12.1% of women aged 65-79 years vs. 7.6% of women aged 85 years and older). With respect to health status, 21.3% were in above-average health, 58.3% were in average

Discussion

Our findings indicate that older women are not receiving the preventive health measures most likely to be effective based on their age and health status. Cancer screening was not targeted to women aged 80 years and older in above-average health even though many of these women have more than 5 years of life expectancy.3 Meanwhile, many women (49%) aged 80 years and older in below-average health were screened with mammography. We also found that many older women did not receive recommended

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    This research was conducted while Dr. Mara Schonberg was supported by a Hartford Geriatrics Health Outcomes Research Scholars Award from the AGS Foundation for Health in Aging.

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