Longitudinal Impact of Self-Rated Health on Preventive Service Utilization Among Older Adults

Background/Purpose: Self-rated health (SRH) refers to a subjective assessment by individuals when asked about their state of overall health. The validity of SRH has been documented in numerous studies and SRH has been widely used a reliable measurement of overall health. SRH is a strong independent predictor of future health-related outcomes such as morbidity, mortality, functional ability, and healthcare utilization. SRH provides clinically relevant information regarding individuals’ overall health status and their health behaviors, but few studies have examined association between SRH and preventive health service utilization among older adults. Preventive health service utilization helps to detect undesirable health conditions at an early stage and increases the opportunities of early treatments. The purpose of this study is to examine to what degree SRH can predict the likelihood of older adults’ utilization of preventive health services (i.e., blood test for cholesterol, influenza vaccination, prostate exam for men, and mammography for women) by using a nationally representative sample of older adults.

Methods: We used data from 1995/1996 to 2014 waves of the Health and Retirement Study (HRS), a longitudinal survey of a nationally representative sample of US adults aged 50 years and older. Participants were included if they were older than 50 years old at the baseline (n=21,401). A composite score of cognitive function, ranging from 0 to 27, was created by summing up scores from immediate and delayed word recall, a serial 7’s, and backwards counting. Follwing Langa, Kabeto, and Weir (2010), a cutoff point of 11 or below was defined as a cognitive impairment; a cutoff point of 6 or below was defined as dementia. Self-report measure of preventive health utilization 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, ADL score, health insurance, and total household income. Mixed-effects logistic regression was applied to examine the relationship between SRH and utilization of preventive health services.

Results: Compared to older adults with higher self-rated health, those with lower self-rated health were 7% more likely to have cholesterol test (OR=1.07, 95 Confidence Interval [CI] = 1.01-1.15, P<.05) and 9% more likely to have flu shot (OR=1.09, 95% CI = 1.02-1.17, P<.05). Older women with lower self-rated health were 14% less likely to report receiving mammogram compared to their counterparts with higher self-rated health (OR=.86, 95% CI = 0.48-.0.96, P<0.1). However, there is no significant association between self-rated health and use of prostate cancer screening among older men.

Conclusions and Implications: This study indicates that there are significant associations between self-rated health and use of preventive health care utilization among older adults - cholesterol test, flu shot, and mammogram. Self-rated health may be useful in identifying older adults who are at risk for lack of preventive health care utilization. This study has important implications for health care providers and social workers to improve access to preventive health services for older adults.