Schonberg Mara A, Leveille Suzanne G, Marcantonio Edward R
Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Am J Med. 2008 Nov;121(11):974-81. doi: 10.1016/j.amjmed.2008.05.042.
Experts recommend that clinicians target mammography and colon cancer screening to individuals with at least 5 years life expectancy. Generally, immunizations and exercise counseling are recommended for all women aged > or =65 years, while Pap smears are generally not encouraged for these women.
We used the 2005 National Health Interview Survey to examine receipt of several preventive health measures simultaneously among community dwelling US women aged > or =65 years by age and health status. We used functional status, significant diseases, and perceived health to categorize women into those most likely to be in above-average, average, or below-average health status. We used age and health status to estimate life expectancy.
Of 4683 participants, 25.8% were > or =80 years; 81.8% were non-Hispanic white; 21% were in above-average and 20% were in below-average health status. Receipt of mammography and colon cancer screening decreased with age and was not associated with health status for women aged > or =80 years. Nearly half (49%) of women aged > or =80 years in below-average health received mammography screening, while 19% of women aged 65-79 years in above-average health did not report receiving mammography. Nearly half of women aged 65-79 years (49%) in above-average health did not report receiving colon cancer screening. Pap smear screening was common among older women. Few (34%) reported receiving exercise counseling. Many did not report receiving pneumococcal (43%) or flu vaccinations (40%).
In our comprehensive review of preventive health measures for older women, we found evidence to suggest a need to improve delivery and targeting of preventive health services.
专家建议临床医生将乳房X线摄影和结肠癌筛查针对预期寿命至少为5年的个体。一般而言，建议所有年龄≥65岁的女性进行免疫接种和运动咨询，而通常不鼓励这些女性进行巴氏涂片检查。
我们使用2005年全国健康访谈调查，按年龄和健康状况同时检查美国≥65岁社区居住女性接受几种预防性健康措施的情况。我们使用功能状态、重大疾病和自我感知健康状况将女性分为健康状况最可能高于平均水平、平均水平或低于平均水平的几类。我们根据年龄和健康状况估计预期寿命。
在4683名参与者中，25.8%的年龄≥80岁；81.8%为非西班牙裔白人；21%的健康状况高于平均水平，20%的健康状况低于平均水平。乳房X线摄影和结肠癌筛查的接受率随年龄下降，且与≥80岁女性的健康状况无关。健康状况低于平均水平的≥80岁女性中近一半（49%）接受了乳房X线摄影筛查，而健康状况高于平均水平的65 - 79岁女性中有19%未报告接受乳房X线摄影检查。健康状况高于平均水平的65 - 79岁女性中近一半（49%）未报告接受结肠癌筛查。巴氏涂片检查在老年女性中很常见。很少有女性（34%）报告接受过运动咨询。许多女性未报告接受过肺炎球菌（43%）或流感疫苗接种（40%）。
在我们对老年女性预防性健康措施的全面审查中，我们发现有证据表明需要改进预防性健康服务的提供和目标定位。
