Determinants of Preventive Health Services Among Older Adults with Dementia

Background and Purpose:

Preventive health services are an important health behavior that offers opportunities for early detection of infectious diseases or chronic illnesses and can prevent or delay illness progression.

The importance of preventive health services for older adults has been well documented and public health officials have highlighted the importance of preventive health care. Utilizing preventive health services is crucial for older adults with dementia, who have a high burden of comorbid conditions. These conditions can accelerate the deterioration of their physical and cognitive function among dementia patients. However, little is known about factors associated with preventive health services among dementia patients. This study aimed to identify barriers and facilitators to the utilization of preventive health services among older adults with dementia.

Methods: We used data from 1995 to 2014 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal health survey. The status for cognitive function is measured using the Telephone Interview for Cognitive Status (TICS). A composite score of cognitive function was created by summing up items of immediate and delayed word recall, serial 7s, and backwards counting for a total of 27-points. Following Langa, Kabeto, and Weir (2010), dementia was defined as a score of 6 or below (total = 19,898, older adults with dementia = 822). Participants were included if they were older than 50 years old at the baseline and the composite score was 6 or below. Four self-reported preventive services were examined: flu shots, cholesterol tests, prostate exams (for male), and mammograms (for female). Covariates included age, race, education, marital status, depression, BMI, chronic disease diagnoses, household income, health insurance, activities of daily living, and self-reported health. Mixed-effects logistic regression was used to identify factors associated with utilizing preventive health services among older adults with dementia.

Results: Findings indicated that older age (OR=1.04, 95% CI=1.02-1.06, p<.001), higher education level (OR=3.18, 95% CI=1.57-6.45, p<.05), having private insurance (OR=1.29, 95% CI=1.06-1.62, p<.01), and higher number of chronic conditions (OR=1.61, 95% CI=1.47-1.76, p<.001) increased the likelihood of utilizing cholesterol test, flu shots, and mammogram among dementia patients. Single/never marital status (OR=0.77, 95% CI=0.62-0.96, p<.05) and living alone (OR=0.68, 95% CI=0.45-0.98, p<.05) were associated with a lower likelihood of utilizing cholesterol test, flu shots, and mammogram among older adults with dementia.

Conclusions and Implications:

Age, education level, insurance, chronic conditions, marital status, and living arrangements were the main determinants of utilizing preventive health services among noninstitutionalized older adults with dementia. The health promotion programs may improve dementia patients’ access to preventive health services by targeting those living alone and unmarried older adults. Healthcare policy for improving access to preventive health services in this population should focus on providing affordable and comprehensive health insurance.