Do Functional Limitations Matter in Breast Cancer Screening Participation for Older Non-Hispanic White and Black Women?

Background and Purpose: The number of older adults has been increasing at significant rates. There is a higher likelihood of older adults having disabilities. Specifically, the prevalence rates in activity of daily living (ADLs) limitations among adults older than 65 years are approximately 15% and 26% in instrumental activities of daily living (IADLs) limitations. Evidence suggests reduced mammography participation among women with disabilities. However, less is known about racial differences. It is critical to understand differences that may exist given national conversations to increase health equity and decrease health disparities.

Methods: Guided by a conceptual framework of the socio-ecological model, we conducted a secondary analysis of the 2008 and 2012 waves of the Health and Retirement Study. We compared the influence of ADL limitations and IADL limitations among non-Hispanic White (NHW) and Black women > 65 years of age on mammography participation rates in 2008 and 2012. We used logistic regression models to determine the influence of ADLs and IADLs on mammography participation.

Results: Regarding ADL limitations in 2008 (n = 3728), NHW women who had not received a mammogram were more likely to report difficulty walking (OR=1.55; p<.05), bathing (OR=1.74; p<.01) and eating (OR=1.33; p<.01) than Black women when controlling for health status and health insurance.  Black women who had not received a mammogram were more likely (OR=1.82; p<.05) to report difficulty bathing than NHW women. With regard to IADL limitations (n= 5823), NHW women who had not received a mammogram were more likely to report difficulty making phone calls (OR=1.81; p<.05) and managing money (OR=1.69, p<.01) than Black women.

Regarding ADL limitations in 2012 (n=3063), NHW women who had not received a mammogram were less likely to report issues with bathing/showering (OR= .43, p<.001) than Black women when controlling for health status and health insurance. Further, Black women who had not received a mammogram were more likely to have difficulty using the toilet (OR=2.45; p<.01) than NHW women. Regarding IADL limitations (n= 4580), NHW women who were less likely to have a mammogram had great ability to make phone calls (OR = .58, p< .05) and manage money (OR =.72, p< .05) than Black women.

Conclusions and Implications: Overall results suggest that ADL and IADL limitations influence cancer screening. There were differences between 2008 and 2012 with ADL and IADL difficulties. Both groups of women indicated reduced mammography participation in 2008 while only Black women indicated reduced mammography participation in 2012 with ADL difficulties. Specifically, there was a relationship between reduced mammography participation and difficulty using the toilet. This could be attributed to a lower overall knowledge of services and supports that are available to assist with ADL limitations. Regarding IADLs, NHW women indicated reduced mammography participation in both years indicated reduced mammography participation with no IADL difficulties. Health social workers are uniquely trained to assess and intervene with older women regarding their decisions to participate in mammography screening to ensure the best possible health outcomes.