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).
Article info
Publication history
Published online: March 10, 2008
Accepted:
December 18,
2007
Received:
July 5,
2007
Footnotes
Funded by an Older Americans Independence Center Grant Pilot Project, a Harvard/Hartford Foundation Junior Faculty Development Grant, a Hartford Geriatrics Health Outcomes Research Scholars Award, and a National Research Service Award from the National Cancer Institute (1 F32 CA110424-01).
Identification
Copyright
© 2008 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
