Unhealthy Drinking Patterns and Receipt of Preventive Medical Services by Older Adults

  • Elizabeth L. Merrick
  • Dominic Hodgkin
  • Deborah W. Garnick
  • Constance M. Horgan
  • Lee Panas
  • Marian Ryan
  • Richard Saitz
  • Frederic C. Blow
Original Article

Abstract

Background

Preventive service use among older adults is suboptimal. Unhealthy drinking may constitute a risk factor for failure to receive these services.

Objectives

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.

Design/Methods

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.

Results

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).

Conclusions

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 WORDS

unhealthy drinking Medicare beneficiaries preventive services older adults 

References

  1. 1.
    Goldberg TH, Chavin SI. Preventive medicine and screening in older adults. J Am Geriatr Soc. 1997;45(3):344–54.PubMedGoogle Scholar
  2. 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.
  3. 3.
    Ozminkowski RJ, Goetzel RZ, Shechter D, Stapleton DC, Baser O, Lapin P. Predictors of preventive service use among Medicare beneficiaries. Health Care Financ Rev. 2006;27(3):5–23.PubMedGoogle Scholar
  4. 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. 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. 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.
  7. 7.
    Kosiak B, Sangl J, Correa-de-Araujo R. Quality of health care for older women: what do we know? Women’s Health Issues. 2006;16:89–99.PubMedCrossRefGoogle Scholar
  8. 8.
    Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA. 2005;294(4):473–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Asch SM, Sloss EM, Hogan C, Brook RH, Kravitz RL. Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claims. JAMA. 2000;284(18):2325–33.PubMedCrossRefGoogle Scholar
  10. 10.
    Moore AA, Morgenstern H, Harawa NT, Fielding JE, Higa J, Beck JC. Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers? J Am Geriatr Soc. 2001;49(4):421–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002;40(5):395–404.PubMedCrossRefGoogle Scholar
  12. 12.
    Klabunde CN, Meissner HI, Wooten KG, Breen N, Singleton JA. Comparing colorectal cancer screening and immunization status in older Americans. Am J Prev Med. 2007;33(1):1–8.PubMedCrossRefGoogle Scholar
  13. 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
  14. 14.
    Merrick EL, Horgan CM, Hodgkin D, Garnick DW, Houghton SF, Panas L, Saitz R. Unhealthy drinking patterns among older adults: prevalence and associated characteristics. JAGS. 2008;56:214–23.CrossRefGoogle Scholar
  15. 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. 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.
  17. 17.
    Moos RH, Brennan PL, Schutte KK, Moos BS. High-risk alcohol consumption and late-life alcohol use problems. Am J Public Health. 2004;94(11):1985–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Branch LG, Rabiner DJ. Rediscovering the patient’s role in receiving health promotion services. Med Care. 2000;38(1):70–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Rabiner DJ, Branch LG, Sullivan RJ Jr. Patient factors related to the odds of receiving prevention services in Veterans Health Administration medical centers. Am J Manag Care. 1999;5(9):1153–60.PubMedGoogle Scholar
  20. 20.
    Rush B, Ellis K, Crowe T, Powell L. How general practitioners view alcohol use - Clearing up the confusion. Can Fam Physician. 1994;40:1570–9.PubMedGoogle Scholar
  21. 21.
    Warburg MM, Cleary PD, Rohman M, Barnes HN, Aronson M, Delbanco TL. Residents’ attitudes, knowledge, and behavior regarding diagnosis and treatment of alcoholism. J Med Educ. 1987;62(6):497–503.PubMedGoogle Scholar
  22. 22.
    Fredman L, Sexton M, Cui Y, et al. Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older. Prev Med. 1999;28:407–17.PubMedCrossRefGoogle Scholar
  23. 23.
    Cryer PC, Jenkins LM, Cook AC, et al. The use of acute and preventative medical services by a general population: relationship to alcohol consumption. Addiction. 1999;94(10):1523–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Druss BG, Rosenheck RA, Desai MM, Perlin JB. Quality of preventive medical care for patients with mental disorders. Med Care. 2002;40(2):129–36.PubMedCrossRefGoogle Scholar
  25. 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. 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. 27.
    DxCG. Products and services, RiskSmart Stand Alone. Available at: http://www.dxcg.com/products-services/risksmart-stand-alone.asp. Accessed June 5, 2008.
  28. 28.
    Zhao Y, Ellis RP, Ash AS, et al. Measuring population health risks using inpatient diagnoses and outpatient pharmacy data. Health Serv Res. 2001;36(6 Pt 2):180–93.PubMedGoogle Scholar
  29. 29.
    Zhao Y, Ash A, Ellis RP, Slaughter JP. Disease burden profiles: an emerging tool for managing managed care. Health Care Manag Sci. 2002;5:211–9.PubMedCrossRefGoogle Scholar
  30. 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. 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.
  32. 32.
    Li C, Friedman B, Conwell Y, Fiscella K. Validity of the patient health questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatr Soc. 2007;55:596–602.PubMedCrossRefGoogle Scholar
  33. 33.
    US Preventive Services Task Force. Recommendations. Available at: http://www.ahrq.gov/clinic/USPSTFix.htm#Recommendations. Accessed June 5, 2008.
  34. 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.
  35. 35.
    Goldberg LD. Clinical guidelines for the treatment of glaucoma. Manag Care. 2002;11(S):16–24.PubMedGoogle Scholar
  36. 36.
    National Committee for Quality Assurance. HEDIS 2005 Volume 2, Technical Manual. Washington DC, 2004.Google Scholar
  37. 37.
    Randolph WM, Mahnken JD, Goodwin JS, Freeman JL. Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms. Health Serv Res. 2002;37(6):1643–57.PubMedCrossRefGoogle Scholar
  38. 38.
    Cohen SB. An evaluation of alternative PC-based software packages developed for the analysis of complex survey data. Am Stat. 1997;51(3):285–92.CrossRefGoogle Scholar
  39. 39.
    Lemeshow S, Letenneur L, Dartigues J, Lafont S, Orgogozo J, Commenges D. Illustration of analysis taking into account complex survey considerations: the association between wine consumption and dementia in the PAQUID study. Am J Epidemiol. 1998;148(3):298–306.PubMedGoogle Scholar
  40. 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.
  41. 41.
    Rice C, Duncan D. Alcohol use and reported physician visits in older adults. Prev Med. 1995;24:229–34.PubMedCrossRefGoogle Scholar
  42. 42.
    Heywood A, Sanson-Fisher R, Ring I, Mudge P. Risk prevalence and screening for cancer by general practitioners. Prev Med. 1994;23:152–9.PubMedCrossRefGoogle Scholar
  43. 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.
  44. 44.
    Armstrong MA, Midanik LT, Klatsky AL. Alcohol consumption and utilization of health services in a health maintenance organization. Med Care. 1998;36(11):1599–605.PubMedCrossRefGoogle Scholar
  45. 45.
    Midanik LT, Clark WB. The demographic distribution of U.S. drinking patterns in 1990: description and trends from 1984. Am J Public Health. 1994;84(8):1218–22.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Elizabeth L. Merrick
    • 1
  • Dominic Hodgkin
    • 1
  • Deborah W. Garnick
    • 1
  • Constance M. Horgan
    • 1
  • Lee Panas
    • 1
  • Marian Ryan
    • 1
  • Richard Saitz
    • 2
    • 3
    • 4
  • Frederic C. Blow
    • 5
    • 6
  1. 1.Institute for Behavioral Health, Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA
  2. 2.Boston University School of Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal MedicineBoston Medical CenterBostonUSA
  3. 3.Youth Alcohol Prevention CenterBoston University School of Public HealthBostonUSA
  4. 4.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  5. 5.Department of PsychiatryUniversity of MichiganAnn ArborUSA
  6. 6.Department of Veterans Affairs, Health Services Research and DevelopmentSerious Mental Illness Treatment Research and Evaluation CenterAnn ArborUSA

Personalised recommendations