Age and Utilization of Preventive Health Services among the Elderly in Five Texas Sites

Age and Utilization of Preventive Health Services among the Elderly in Five Texas Sites

Exponentiating the coefficients of I3s in the logit regression models yielded odds ratios for the PHS variables. For each PHS, odds ratios were also calculated for time 2 vs. time I and time 3 vs. time 2 after adjusting for the nested structure.

Covariates including patients' gender, reasons for visit (acute condition or check-up or treatment of a chronic condition), number of clinic visit in the past 12 month and medical and risk factor history form use) were controlled at the equation mentioned above in order to examine the effects of PPIP intervention and age.

Results

Relationship Between Age and the Delivery Rates of Selected PHS

As shown in Table 3, there were significant inverse relationships between age and the selected PHS among the elderly on delivery rates for 9 of the 30 time/PHS pairs examined. Screening Tests. Because blood pressure (BP) screening was universally delivered to the elderly subjects, there is no variance to be analyzed. When the elderly patients were older, they were less likely to receive cholesterol screening at time I (odds ratio

=

0.84) and time 3 (odds ratio

=

0.92) (Table 3). That is, the increase of one year of age among elderly adults was associated with a 16% (1-0.84

=

0.16) decrease in the probability of receiving cholesterol screening at time 1. Similarly, a one year increase in age was associated with a 8% (1-0.92

=

0.08) decrease in the possibility of receiving this service among elderly patients at time 3. However, the age-related inverse relationship between advancing age and receipt of cholesterol screening was not significant at time 2. The association between advancing age and receipt of the Papanicolaou test was only significant at time 2 (odds ratio

= 0.79). The older the elderly women were, the less likely they were to receive a Papanicolaou test at time 2 (Table 3). The associations between advancing age and receipt of a yearly mammogram were not significant at any of the three time points.

Life Style Assessments and Counseling. As age increased, elderly adults were less likely to receive smoking assessment at time 3 (odds ratio

=

0.89) but there were no significant associations between age and receipt of smoking assessment at times 1 and 2 (Table 3). Also, elderly adults of increasing age were less likely to receive smoking counseling at time I (odds ratio = 0.78); there were no significant associations between age and reception of

35-smoking counseling at times 2 and 3. As age increased, elderly adults were less likely to receive physical activity assessment at all three time points (Table 3). There was a negative association between age and physical activity counseling at time 1 (odds ratio

=

0.71), but there were no significant associations between age and reception of physical activity counseling at times 2 and 3. The older elderly were less likely to receive nutrition assessment (odds ratio

=

0.94) at time 3 but there were no significant associations between age and receipt of nutrition assessment at times 1 and 2 (Table 3). No differences were found between age and nutrition counseling at the three time points.

Immunizations. The negative association between advancing age and reception of Td immunization at time 2 was the only Age/Td relationship that reached a significant level (odds ratio

=

0.83) (Table 3). No age-related inverse relationship existed for the delivery of pueumococal and influenza immunizations.

Table 3. The association between advancing age and delivery rates of selected preventive health services among elderly patients at time 1, time 2 and time 3

Time 1 Time 2 Time 3

n Odds Ratio· (95% C.I.) p n Odds Ratio (95% C.I.) p n Odds Ratio (95%c.l.) p (0.84, <.001 (0.87,0.11 (0.91, <.01 (0.80,0.08 68 0.78 (0.73, 0.83) <.001 71 0.99 (0.90, 1.09) 0.88 65 68 0.95 (0.92, 0.98) <.01 71 0.92 (0.91, 0.94) <.001 65 65 0.89 0.94) 0.97 (0.8, 1.09) 0.14 0.94 (0.91, <.001 0.98) 68 0.71 (0.51,0.99) 0.04 71 0.90 (0.80, 1.02) 0.09 65 0.94 1.02) 68 0.97 (0.90, 1.05) 0.36 71 0.95 (0.88, 1.03) 0.29 65 0.94 0.98) 68 0.97 (0.92, 1.03) 0.31 71 0.98 (0.94, 1.02) 0.45 65 0.90 1.01) Physical activity counseling

Screening Tests

Papanicolaou test (women only) 37 0.99(0.95, 1.03) 0.66 29 0.79 (0.63,0.98) 0.03 29 0.93 (0.8, 1.03) 0.16 Life Style Assessment and Counseling

Tobacco/ Smoking cessation 68 0.97 (0.90, 1.05) 0.57 71 0.98 (0.92, 1.04) 0.46 assessment

Tobacco/ Smoking counseling Physical activity assessment

Nutrition counseling Nutrition assessment 27 1.01 (0.99, 1.03) 0.91 23 0.83 (0.71, 0.97) 0.02 21 0.90 (0.80, 0.10 1.02) 68 0.97 (0.94, 1.00) 0.07 71 0.99 (0.92, 1.07) 0.80 65 0.97 (0.92,0.29 1.03) 680.95 (0.90,1.01) 0.10 71 0.99 (0.93, 1.05) 0.74 65 0.96 (0.91,0.12 1.02) Influenza immunization Immunizations Tetanus-Diphtheria immunization Pneumococcal immunization

Odds ratios are adjusted for clinics. This table indicates that a one-age increase in the older adults is associated with the decrease with certain percentage in the receipt of selected PHS