Long-term Care

Improved recognition and treatment of emotional problems may indirectly improve the elderly's use of preventive care

Elderly people suffering from depression or other emotional problems are much less likely than their nondistressed counterparts to receive certain types of recommended preventive care, concludes a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00032). For instance, elderly people with high levels of psychological distress were 30 percent less likely to receive flu shots, and 23 percent less likely to receive annual dental check-ups.

Also, distressed elderly women were 27 percent less likely to receive a clinical breast examination than their nondistressed counterparts. However, psychological distress was not significantly associated with routine checkups, mammography screening, or screening for hypertension, colon cancer, high cholesterol, or prostate cancer. These findings held after controlling for other factors affecting receipt of preventive care. This suggests that adherence to recommended preventive care guidelines may be improved indirectly by improving recognition and treatment of psychological distress in the elderly, concludes Joshua M. Thorpe, Ph.D., M.P.H., of the University of North Carolina at Chapel Hill.

He points out that the distressed group of elderly patients had significantly more total outpatient medical visits than the nondistressed group. It could be that distressed patients are more likely to access specialty providers, who do not routinely deliver services such as flu shots, dental exams, and clinical breast exams. On the other hand, primary care providers may appropriately focus on addressing the distressed patient's specific reasons for medical visits and miss opportunities to deliver more routine preventive care. The findings were based on analysis of mental health and receipt of 9 preventive care services among 3,655 U.S. community-dwelling elderly, as seen in the 2001 Medical Expenditure Panel Survey of U.S. households.

More details are in "Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States," by Dr. Thorpe, Carolyn T. Kalinowski, M.P.H., Mark E. Patterson, M.P.H., and Betsy L. Sleath, Ph.D., in the February 2006 Medical Care 44(2), pp. 187-191.

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