Prevention Services Lacking for Older Adults
|Tuesday, March 29, 2011 at 09:27 AM
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Expanded insurance coverage of effective prevention services is a cornerstone of heath reform in private insurance as well as Medicare and Medicaid. Many older Americans are not receiving preventive services, even those who see their doctor regularly. Research demonstrates preventive services not only prevent disease and improve quality of life, but they also are critical to healthy living and independence, lowering the costs of care in the long run.
About 10,000 Americans turn 65 every day and by 2030, about one in five Americans will be 65 or older. As the population ages, the use of prevention services will become increasingly important. Preventive services need to be promoted to adults age 65 and older, especially among minorities, so they are aware of the coverage for prevention services available to them, including the coverage enacted through the Affordable Care Act.
While nearly 90 percent of Medicare beneficiaries visit a physician at least once a year and make an average of six visits during the year, many do not receive the full range of recommended preventive services. Expanding coverage for prevention services and removing the cost barrier has much potential to improve use of these services. But eliminating costs is not enough.
Low-income Americans and racial and ethnic minorities have higher rates of disease, fewer treatment options and more limited access to care. The reasons for these disparities are especially complex for older adults because they may:
- Be unaware of recommended preventive services and that coverage is available through Medicare;
- Not have a primary care provider or may not see their provider regularly;
- Face physical or social barriers that keep them from using services, such as transportation, disabilities, culture or language challenges;
- Fear test results or pain related to a preventive service;
- Rely on their physicians to recommend services; or
- Have providers that do not recommend preventive services because they don’t remember, don’t want to take the time or are unaware of the efficacy of recommended vaccines and other preventive services in the elderly.
A recent multi-agency federal report identifies the number of older adults in each state that do not receive clinical prevention services, including screenings for the early detection of colorectal cancer, diabetes, lipid disorders and breast cancer, and vaccinations against influenza and pneumococcal disease such as meningitis and pneumonia.
The study also identifies disparities in use of preventive services and found that:
- 9 percent of Asian/Pacific Islanders and 47 percent of Hispanics report not being screened for colorectal cancer, in comparison to 34 percent of whites.
- More than 50 percent of Hispanics, 47 percent of blacks and Asians, and 36 percent of whites report never receiving a pneumococcal vaccination.
About one-third of white older adults have not received the recommended preventive services (see Disparities chart), but nearly one-half of black, Hispanic and Asian older adults have not received one or more recommended preventive services.
Policymakers are recommending ways to assure that older adults take advantage of preventive services on a regular basis to ensure their good health. Several public strategies at the local, state and national levels can increase use of preventive services in underserved communities.
Recommended approaches include:
- Promoting policies to increase community access to services;
- Reduce copayments;
- Make services available in convenient community settings, such as providing influenza vaccinations at polling places on election days; and
- Build awareness through media campaigns.
Integrating activities at the community level to reach all older Americans is important to link community, public health and clinical primary care efforts. Public health departments are partnering with aging services networks to disseminate information about preventive services, and these efforts are being supported by the federal Centers for Disease Control and Prevention, Administration on Aging, Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services.
Centers for Disease Control and Prevention, Administration on Aging, Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services. Enhancing Use of Clinical Preventive Services Among Older Adults. Washington, DC: AARP, 2011. Available