Unhealthy Drinking Patterns and Receipt of Preventive Medical Services by Older Adults
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Preventive service use among older adults is suboptimal. Unhealthy drinking may constitute a risk factor for failure to receive these services.
To determine the relationship between unhealthy drinking and receipt of recommended preventive services among elderly Medicare beneficiaries, applying the framework of current alcohol consumption guidelines.
The data source is the nationally representative 2003 Medicare Current Beneficiary Survey. The sample included community-dwelling, fee-for-service Medicare beneficiaries 65 years and older (N = 10,523). Based on self-reported drinking, respondents were categorized as nondrinkers, within-guidelines drinkers, exceeding monthly but not daily limits, or heavy episodic drinkers. Using survey and claims data, influenza vaccination, pneumonia vaccination, glaucoma screening, and mammogram receipt were determined. Bivariate and logistic regression analyses were conducted.
Overall, 70.3% received flu vaccination and 49% received glaucoma screening during the year, 66.8% received pneumonia vaccination, and 56.2% of women received a mammogram over 2 years. In logistic regression, heavy episodic drinking was associated with lower likelihood of service receipt compared to drinking within guidelines: flu vaccination (OR 0.75, CI 0.59–0.96), glaucoma screening (OR 0.74, CI 0.58–0.95), and pneumonia vaccination (OR 0.75, CI 0.59–0.96). Nondrinkers when compared with those reporting drinking within guidelines were less likely to receive a mammogram (OR 0.83, CI 0.69–1.00).
Heavy episodic drinking is associated with lower likelihood of receiving several preventive services. Practitioners should be encouraged to screen all elders regarding alcohol intake and in addition to appropriate intervention, consider elders reporting heavy episodic drinking at higher risk for non-receipt of preventive services.
KEY WORDSunhealthy drinking Medicare beneficiaries preventive services older adults
- 2.U.S. Government Accounting Office. Medicare preventive services, most beneficiaries receive some but not all recommended services. GAO Report. 2004;1–12. Available at: http://www.gao.gov/new.items/d041004t.pdf. Accessed June 5, 2008.
- 4.US Census Bureau News. Census Bureau projects tripling of Hispanic and Asian populations in 50 years; non-Hispanic whites may drop to half of total population. Available at: http://www.census.gov/Press-Release/www/releases/archives/population/001720.html. Accessed June 5, 2008.
- 5.Centers for Medicare and Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2005. Fed Regist. 2004;69(219):66235–66915. Available at: http://www.access.gpo.gov/su_docs/fedreg/a041115c.html. Accessed June 5, 2008.
- 6.Centers for Medicare and Medicaid Services. Medicare “pay for performance (P4P)” initiatives. Available at: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1343. Accessed June 5, 2008.
- 13.Saitz R. Medical and Surgical Complications of Addiction. In: Graham AST, Mayo-Smith M, Ries R, Wilford BB, ed. Princ. of Addic Med. 3rd ed.: Chevy Chase, MD: ASAM. 2003:1027–52.Google Scholar
- 15.American Geriatrics Society Clinical Practice Committee. Clinical guidelines for alcohol use disorders in older adults. Available at: http://www.americangeriatrics.org/products/positionpapers/alcohol.shtml. Accessed June 5, 2008.
- 16.National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much. A Clinician’s Guide. 2005 Edition. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf. Accessed June 5, 2008.
- 25.Centers for Medicare and Medicaid Services. Medicare current beneficiary survey overview. Available at: http://www.cms.hhs.gov/MCBS/Downloads/CNP_2003_appendixA.pdf. Accessed June 5, 2008.
- 26.Centers for Medicare and Medicaid Services. MCBS main study - round 37 - fall supplement 2003 community component HF. Health Status and Functioning; 2003. Available at: http://www.cms.hhs.gov/MCBS/Downloads/2003_CBQ_hs.pdf Accessed June 5, 2008.
- 27.DxCG. Products and services, RiskSmart Stand Alone. Available at: http://www.dxcg.com/products-services/risksmart-stand-alone.asp. Accessed June 5, 2008.
- 30.Wang MC, Rosen AK, Kazis L, Loveland S, Anderson J, Berlowitz D. Correlation of risk adjustment measures based on diagnoses and patient self-reported health status. Health Serv Outcomes Res Method. 2000;1(3–4):351–65.Google Scholar
- 31.The Hartford Institute for Geriatric Nursing, Best Practices in Nursing Care to Older Adults. Katz Index of Independence in Activities of Daily Living (ADL). Available at: http://www.hartfordign.org/publications/trythis/issue02.pdf. Accessed June 5, 2008.
- 33.US Preventive Services Task Force. Recommendations. Available at: http://www.ahrq.gov/clinic/USPSTFix.htm#Recommendations. Accessed June 5, 2008.
- 34.Centers for Disease Control. Recommended adult immunization schedule. Available at: http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/06–07/adult-schedule-11x17-bw.pdf. Accessed June 5, 2008.
- 36.National Committee for Quality Assurance. HEDIS 2005 Volume 2, Technical Manual. Washington DC, 2004.Google Scholar
- 40.National Institute on Alcohol Abuse and Alcoholism. National epidemiological survey on alcohol and related conditions. Alcohol Alert. Available at: http://pubs.niaaa.nih.gov/publications/AA70/AA70.htm. Accessed June 5, 2008.
- 43.National Cancer Institute. Estimating breast cancer risk: questions and answers. NCI Fact Sheets. Available at: http://www.cancer.gov/cancertopics/factsheet/estimating-breast-cancer-risk. Accessed June 5, 2008.