Schonberg Mara A, York Meghan, Basu Nisha, Olveczky Daniele, Marcantonio Edward R
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Womens Health Issues. 2008 Jul-Aug;18(4):249-56. doi: 10.1016/j.whi.2007.12.004. Epub 2008 Mar 10.
We sought to examine the use of preventive health services among older women and to assess how age and illness burden influence care patterns.
The charts of 299 women aged > or =80 and 229 women aged 65-79 years who did not have dementia or terminal illness at 1 academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise), and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI).
Women aged > or =80 were more likely than women aged 65-79 to have a CCI of > or =3 (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged > or =80 and was not targeted to older women in good health. Women aged > or =80 were less likely to be screened for depression (adjusted relative risk [aRR] 0.6; 95% confidence interval [CI], 0.5-0.8), osteoporosis (aRR, 0.6; 95% CI, 0.5-0.9), or counseled about exercise (aRR 0.8; 95% CI, 0.6-0.9) than younger women, but were more likely to receive counseling about falls (aRR 1.9; 95% CI, 1.4-2.6) and/or incontinence (aRR 1.8; 95% CI, 1.2-2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%), or incontinence (20.8%) were low among all women.
In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is a need to improve delivery of preventive health care to older women.
我们试图研究老年女性预防性健康服务的使用情况，并评估年龄和疾病负担如何影响护理模式。
2005年7月至12月期间，对波士顿一家学术初级保健机构中299名年龄≥80岁且无痴呆或晚期疾病的女性以及229名年龄在65 - 79岁之间的女性的病历进行审查，以确定是否接受筛查测试（如乳房X线摄影）、健康生活方式咨询（如运动）和/或老年健康问题咨询（如尿失禁）以及免疫接种。使用Charlson合并症指数（CCI）对疾病负担进行量化。
年龄≥80岁的女性比年龄在65 - 79岁之间的女性更有可能CCI≥3（24.0%对16.7%），并且接受所有筛查测试的可能性更小。然而，乳房X线摄影（47.8%）和结肠癌筛查（51.2%）在年龄≥80岁的女性中仍然很常见，且并非针对健康状况良好的老年女性。年龄≥80岁的女性接受抑郁症筛查（调整后相对风险[aRR] 0.6；95%置信区间[CI]，0.5 - 0.8）、骨质疏松症筛查（aRR，0.6；95% CI，0.5 - 0.9）或接受运动咨询（aRR 0.8；95% CI，0.6 - 0.9）的可能性低于年轻女性，但接受跌倒咨询（aRR 1.9；95% CI，1.4 - 2.6）和/或尿失禁咨询（aRR 1.8；95% CI，1.2 - 2.6）的可能性更高。然而，所有女性中记录有关情绪（28.6%）、运动（40.0%）、跌倒（28.8%）或尿失禁（20.8%）讨论的记录较低。
在对老年女性预防性健康措施的全面审查中，许多健康状况不佳的女性接受了癌症筛查。与此同时，许多老年女性没有接受抑郁症筛查或接受运动、跌倒或尿失禁方面的咨询。有必要改善老年女性预防性医疗保健的提供。
