Filling the Gaps in Preventive Care Services for Older Adults
Authors: Rita Rubin
Journal: JAMA (2015)

OnElectionDay2012, voters atpolling places in 48 US states could choosenotonlyapresidential candidate butwhether to get a flu vaccination. More than9000votersopted tobe immunized through the “Vote and Vax” program that year, andmore than half of them reported that they did not regularly get flu shots (Shenson D et al. Am J Public Health. doi:10.2105/AJPH.2015.302628 [published online April 16th 2015]). While likely not the first setting that comes to mind, the polling place represents a logical location for efforts to boost the rate of older individuals who are up-todateoncorepreventive services suchas immunization. After all, more than half of the more than 120 million voters in a US presidential election are 50 years or older, said Douglas Shenson,MD,MPH,national director of Vote and Vax. There’s definitely room for improvement, especially considering the “silver tsunami,” consisting mostly of aging baby boomers. The US population 65 years or older is expected to more than double between 2010 and 2050, when it will swell to nearly 89million (Ogden LL et al.AmJPublic Health. 2012;102[3]:419-425). Today in the United States, fewer than half of people aged 65 years and older are up-to-dateon thecoresetof clinicalpreventive services: screening tests, immunizations, health behavior counseling, and preventivemedications.Onlyaquarterof those aged 50 to 64 years meet preventive services recommendations (http://1.usa.gov /1MUJN7B). And black and Hispanic older adults are even less likely to receivepreventive services than theirwhitepeers (http://1 .usa.gov/1FsnzV8). For example, the proportion of people 60 years and older in the United States who reported receiving a herpes zoster vaccination, as recommended for that age group, was only 24.2% in 2013—below the Healthy People 2020 goal of 30%, according to a recent report from the Centers for Disease Control and Prevention (CDC) (Williams WW et al. Morb Mortal Wkly Rep. 2015;64[4]:95-102). Similarly, for those 65 years and older, the recommended age group for the pneumococcal vaccine, 59.7% reported having gotten that shot—again, far below the Healthy People 2020 goal of 90%. Some Healthy People 2020 goals related topreventive services forolder adults, such as having a mammogram within the past 2 years and having been screened for colorectal cancer, have already been met. But theUnitedStatesstill falls shortof reaching 2020 targets for other preventive services, as well as the goal of having 46% of menand43.1%ofwomen65yearsandolder up-to-date on all of the core services (http: //1.usa.gov/1NzFtYV and http://1.usa.gov /1LGY5aA). “Whenwe’re less than 50%,we have a long way to go,” Lynda Anderson, PhD, director of the CDC’s Healthy Aging Program, said in an interview. “It’s interesting that people who are getting some of these (services) aren’t getting all of them.” Research shows that only aminority of Medicare enrollees take advantage of the freeannualpreventivevisits theprogrambegan offering in 2011, and even those older adultswhoseeadoctor regularlyarenotupto-date on preventive services. Typically, chronic conditions get the mostattentionatolderpatients’medical appointments,Andersonsaid. “A lotof thepreventive issuesdon’t rise to the top,” shesaid. “If their provider isn’t telling them it’s important toget that vaccination, inadvertently it does send the message that it’s not important.” Shenson, an associate clinical professor of epidemiology at the Yale School of Medicine who has studied the issue for nearly 20 years, says conventional wisdom used to place the blame squarely on physicians andpatients: physicians didn’t place a high priority on preventive care, patients didn’t ask for itorweren’t receptive to it, and physicians’ officesneglected to flag the records for patientswhohadn’t receivedaparticular vaccine or screening. No question, all of those factors play a role.But the rootsof theproblemextendbeyond the physician’s office to a US health Medical News&Perspectives.....p1604