The Influence of Cognitive Impairment on Preventive Service Utilization Among Older Adults

Background/Purpose: Preventive healthcare utilization is an important health promotion behavior, which helps to identify unwanted health conditions or disease at an early stage and increases options for treatment, thus avoiding adverse health outcomes. The utilization of preventive services, such as early detection of chronic conditions or illnesses, and annual influenza vaccinations are effective in reducing mortality and the need for subsequent inpatient services among older adults. The benefits of utilization of preventive care services are well documented in older adults. However, we have little information on whether individuals with cognitive impairment are able to access preventive health screening. Since self-care requires cognitive ability for learning, perceiving, interpreting, reasoning, and responding, cognitive impairment could substantially diminish a person’s ability to consistently perform self-care and may be a strong predictor for utilization of preventive health services. The purpose of this study is to examine the influence of cognitive impairment on utilization of preventive health care services among older adults.

Methods: Data came from 1995 to 2012 of the Health and Retirement Study (HRS), a multistage national probability sample of older adults in the U.S (n = 19,556). The status for cognitive impairment is measured using the Telephone Interview for Cognitive Status (TICS). An overall cognitive score was calculated from summing up items of immediate and delayed word recall, s serial 7’s, and backwards counting, for a total of 27-points. Cognitive impairment was defined as a score of 11 or below while dementia was defined as a score of 6 or below. Self-report measure of preventive health services in this study included a cholesterol test, a flu shot, a mammogram, and prostate cancer screening. Covariates included age, race, education, marital status, depression, BMI, chronic disease diagnoses, health insurance, and total household income. Mixed-effects logistic regression was used to analyze the longitudinal influence of cognitive impairment on utilization of preventive health services

Results: Older adults who had cognitive impairment or dementia were 31% and 56% less likely to report receipt of a cholesterol test during follow-up (OR=0.69, p<.001; OR=0.44, p<.001). Compared with older women with no cognitive impairment, older adults with mild cognitive impairment or dementia were 23% and 37% less likely to receive mammograms (OR=0.87, p<.05; OR=0.63, p<.01). Older men with mild cognitive impairment or dementia were 22% and 39% less likely to receive prostate cancer screening compared to their counterparts (OR=0.79, p<.01; OR=0.61, p<.05). Compared with their non-cognitively impaired counterparts, individuals with cognitive impairment or dementia were 16% and 32% less likely to report receipt of influenza vaccination (OR=0.83, p<.001; OR=0.68, p<.001).

Conclusions and Implications: There were significant associations between cognitive function and usage of all preventive services. The current study has several important implications for social workers and healthcare providers tasked with promoting health behaviors and disease prevention. Policies aiming at promoting intervention to improve utilization of preventive health services should address the needs and difficulties experienced by people with cognitive impairment or dementia.