Abstract
Background A small number of preventive services are recommended for all adults ages 65 years and older. It is well established that the combined delivery or being “up to date” on these measures is low. However, the effect of routine checkups on being up to date is not known. We examined the association between routine checkups and the delivery of a group of recommended clinical preventive services for US adults ages 65 and older.
Methods In 2006 the Behavioral Risk Factor Surveillance System conducted telephone surveys. Participants ages 65 years and older were randomly selected in 50 states and the District of Columbia. Sample sizes were 32,243 male respondents and 58,762 female respondents. A composite measure was used that includes screening for colorectal, cervical, and breast cancers, and vaccinations against influenza and pneumococcal disease. The measure quantifies the percentage of adults who are up to date according to recommended schedules.
Results Most adults ages 65 and older were fully insured, had a personal health care provider, reported no cost barrier to seeing a doctor in the past year, and had recently received a routine checkup. Associations between high health care access and checkups and the increased likelihood of being up to date on clinical preventive services were statistically significant. Although a large percentage of the population had high access to care and reported having a recent checkup, the percentage of all those who were up to date was low, and it was only slightly greater for those with high access or a recent checkup (42.6%, 45.1%, and 44.8%, respectively, for men; 35.2%, 37.0%, and 36.8%, respectively for women). For both sexes, the results varied by education, race/ethnicity, marriage, insurance, health, and state.
Conclusions Our study indicates that increasing the use of routine medical checkups will have a negligible impact on the delivery of preventive services.
Just because elderly patients are having regular checkups does not necessarily mean they are receiving needed preventive services. For individuals who are ages 65 and older, such services include vaccinations against influenza and pneumonia, screenings for hypertension and hypercholesterolemia, and screenings for breast, cervical, and colorectal cancers.1
Recently analyzed state and national data for a cluster of 5 of these services indicate that fewer than 41% of men and 32.5% of women ages 65 and older were up to date.2 Time constraints on health care providers and a lack of knowledge about guidelines are perhaps 2 of the biggest barriers to widespread provision of disease prevention services. In this study we extended an earlier analysis and examined, for individuals 65 years of age and older, the association between having a recent checkup and being up to date on a cluster of recommended preventive services. We also propose steps that will likely be needed to increase receipt of preventive services.
Methods
Data source
The Behavioral Risk Factor Surveillance System (BRFSS), coordinated by the Centers for Disease Control and Prevention (CDC), conducts annual state-based telephone surveys of noninstitutionalized US adults ages 18 years or older concerning health practices.3 We used data from 2006 BRFSS participants ages 65 years or older at the time they participated (32,243 male respondents and 58,762 female respondents). All results were based on weighted data that accounted for different probabilities of selection and were adjusted to reflect the population distribution in each state by age and sex, or by age, race, and sex.
Respondents queried about preventive services
We analyzed responses to BRFSS questions about the receipt of clinical preventive services recommended by the US Preventive Services Task Force (USPSTF) or by the Advisory Committee on Immunization Practices for all adults ages 65 or older.* Services included colorectal cancer screening, influenza immunization, pneumococcal immunization, and, for women, mammography and the Papanicolaou (Pap) test. The USPSTF grades these measures* as A or B, meaning it finds “good” or at least “fair” evidence that a service improves important health outcomes and concludes that benefits substantially outweigh harms.4 Questions about these services were asked in all 50 states in 2006.
*The recommendations and grading systems discussed here reflect those that were in place in 2006. There have been changes to both since this study was conducted.
Cardiovascular services excluded. The BRFSS has not asked questions about hypertension screening since 1999, when more than 95% of older adults reported they had their blood pressure checked in the past 2 years.5 Questions about cholesterol screening were not asked in all states in 2006 and were not incorporated into the composite measure. However, analysis from a prior study suggests that including cholesterol screening levels in such a composite measure would not have made a large difference in the percentage of older Americans up to date on all services.2