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HIN (02/09/06): Poor Emotional Health Is Barrier to Preventive Care in the Elderly

Poor emotional health, such as symptoms of depression and anxiety, may significantly reduce the likelihood that elderly patients will receive preventive health services, according to a study led Joshua Thorpe, Ph.D., MPH, assistant research professor in the School of Nursing and senior fellow in the Duke University Center for Aging. The researchers said their findings lead them to recommend that physicians actively screen older patients to determine if they might be experiencing symptoms of psychological distress.

• The study included an analysis of survey data from approximately 3,700 elderly individuals – a group that represented 33.8 million community-dwelling elderly living in the United States .
• Results showed that distressed elderly were 30 percent less likely to receive an influenza vaccine, 23 percent less likely to receive an annual dental check-up, and distressed women were 27 percent less likely to undergo a clinical breast examination. The researchers controlled for many outside factors that could affect patient behavior, including age, sex, race/ethnicity, marital status and education.
• Psychologically distressed women are also less likely to receive mammograms. For this preventive service, the study focused on women ages 65 to 69. Of that group, women under distress were 32 percent less likely to receive the test. Because the respondent population for mammograms was smaller than for other services in the study, Thorpe said, while somewhat significant, the relationship between mammography and distress should be studied in greater depth.
• The prevalence of depression among the elderly ranges from 10 percent to 50 percent, depending on their health, activity level and living situation, according to the Hartford Institute for Geriatric Nursing. However, physicians screen for psychological distress in only 14 percent of elderly primary care visits, according to previous research published in Medical Care. According to that previous research, physicians used a formal screening tool in only three out of 389 encounters.

Sources: HIN Daily Data Byte; Duke University Center for Aging, February 1, 2006