Kosiak Beth, Sangl Judy, Correa-de-Araujo Rosaly
Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
Womens Health Issues. 2006 Mar-Apr;16(2):89-99. doi: 10.1016/j.whi.2005.01.003.
As the proportion of the population age 65 and over continues to grow--to a projected 20.5% or 77.2 million by the year 2040--tracking the quality, access, and receipt of care for older women becomes more important, since the majority of older citizens are women. This article establishes a rough baseline for the quality of care, primarily preventive care, received by older women compared to older men, using selected measures and data of the 2004 National Healthcare Quality Report and National Healthcare Disparities Report. It highlights significant differences between women and men, as well as differences for racial, ethnic, and educational subgroups. Generally, older non-Hispanic white women frequently score higher than their Hispanic and non-Hispanic black counterparts, and more educated women often score significantly higher than their less-educated peers on several measures of quality of care. Compared to their male counterparts, older women are significantly less likely to have any colorectal screening test, to keep high blood pressure under control, and to receive aspirin or beta-blockers upon hospital admission or discharge for acute myocardial infarction. Results are mixed for the process measures related to diabetes, but improvements are clearly needed toward increased rates of eye and foot examinations. Rates of influenza and pneumococcal vaccinations are low but can be improved through Medicare-covered services. We also found that older women are screened less often for breast cancer than those ages 40 to 64. There is still a pervasive lack of knowledge in the research and clinical communities about the unique health care needs of and appropriate processes of care for older adults. More research needs to focus on the quality of care for this growing population in order to allow the development of geriatric-based quality measures and models of care that will set the standards of healthcare for older adults in general, and older women in particular.
随着65岁及以上人口比例持续增长——预计到2040年将达到20.5%或7720万——追踪老年女性的护理质量、可及性和护理接受情况变得更加重要，因为大多数老年公民是女性。本文利用《2004年国家医疗质量报告》和《国家医疗差异报告》中的选定指标和数据，为老年女性与老年男性相比所接受的护理质量（主要是预防性护理）建立了一个大致的基线。它突出了男女之间的显著差异，以及种族、族裔和教育亚组之间的差异。一般来说，非西班牙裔白人老年女性的得分通常高于西班牙裔和非西班牙裔黑人老年女性，在几项护理质量指标上，受教育程度较高的女性得分往往明显高于受教育程度较低的同龄人。与男性同龄人相比，老年女性进行任何结肠直肠癌筛查测试、控制高血压以及在因急性心肌梗死住院或出院时接受阿司匹林或β受体阻滞剂治疗的可能性显著更低。与糖尿病相关的过程指标结果不一，但显然需要提高眼科和足部检查的比例。流感和肺炎球菌疫苗接种率较低，但可以通过医疗保险覆盖的服务得到改善。我们还发现，老年女性接受乳腺癌筛查的频率低于40至64岁的女性。研究和临床界对老年人独特的医疗保健需求以及适当的护理流程仍然普遍缺乏了解。需要更多研究关注这一不断增长的人群的护理质量，以便制定基于老年医学的质量指标和护理模式，从而总体上为老年人，尤其是老年女性设定医疗保健标准。
