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Preventive Health Care Among Older Women in an Academic Primary Care Practice

Published:March 10, 2008DOI:https://doi.org/10.1016/j.whi.2007.12.004

      Purpose

      We sought to examine the use of preventive health services among older women and to assess how age and illness burden influence care patterns.

      Methods

      The charts of 299 women aged ≥80 and 229 women aged 65–79 years who did not have dementia or terminal illness at 1 academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise), and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI).

      Results

      Women aged ≥80 were more likely than women aged 65–79 to have a CCI of ≥3 (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged ≥80 and was not targeted to older women in good health. Women aged ≥80 were less likely to be screened for depression (adjusted relative risk [aRR] 0.6; 95% confidence interval [CI], 0.5–0.8), osteoporosis (aRR, 0.6; 95% CI, 0.5–0.9), or counseled about exercise (aRR 0.8; 95% CI, 0.6–0.9) than younger women, but were more likely to receive counseling about falls (aRR 1.9; 95% CI, 1.4–2.6) and/or incontinence (aRR 1.8; 95% CI, 1.2–2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%), or incontinence (20.8%) were low among all women.

      Conclusion

      In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is a need to improve delivery of preventive health care to older women.
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      Biography

      Mara Schonberg, MD, MPH, is an Instructor in Medicine in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School. She is a clinician-researcher whose research is aimed at improving the quality of preventive health care delivered for older women.

      Biography

      Meghan York, MD, is an Instructor in Medicine in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School. She is currently working as a hospitalist at Beth Israel Deaconess Medical Center.

      Biography

      Nisha Basu, MD, MPH, is an Instructor in Medicine in the Division of General Medicine and Primary Care.

      Biography

      Daniele Ölveczky, MD, is currently completing her Harvard Geriatrics Fellowship. She is interested in the study of acute and chronic locomotor syndromes in the elderly.

      Biography

      Edward Marcantonio, MD, SM, is an Associate Professor in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School. He is a geriatrician and health services researcher whose focus is the prevention and management of delirium in surgical patients and across the continuum of care (from the hospital into rehabilitation and community settings).