An important Healthy People 2010 objective is ensuring adequate and timely access to health care for individuals of all ages.17
Toward that goal, the USPSTF made evidence-based recommendations on a number of preventive care services for all adults 65 years and older. Using nationally representative data from the 2002 to 2005 MEPS, we examined the association between household living arrangement and the elderly’s adherence to these recommendations. We hypothesized that living with others (a spouse, adult offspring, or both)would improve elderly persons’ adherence to recommended preventive care. This hypothesis was only partially supported.
Consistent with our hypothesis, our findings indicated that compared with those living alone, elderly adults living with their spouse were more likely to use preventive care. By contrast, elderly adults living with adult offspring, even with the presence of a spouse, were similar to those living alone with respect to obtaining recommended preventive care. For some services, living with adult offspring actually indicated a lower likelihood of adhering to preventive care guidelines. Further analyses accounting for employment status and functional status of adult offspring produced similar findings. These findings did not change even when many of the elderly adults’ sociodemographic and health characteristics were held constant.
Our findings raise an obvious question for future research: Among elderly persons, why does living with one’s spouse aid in the timely use of preventive services whereas living with adult offspring does not, when compared with elderly persons living alone? Prior studies have found that spouses often play important roles in providing emotional and instrumental support and influencing an individual’s health behaviors and illnesses.19,20
Perhaps because of shared life and health experiences or being in the same age cohort, elderly adults and their spouses may help each other in accessing preventive care by reminding each other of health examinations or assisting each other in traveling to health care facilities together. Moreover, parent–child relationships may differ from spousal relationships in terms of the social support and caregiving provided.
Understanding the characteristics that predispose elderly adults to live with their adult offspring or that predispose adult offspring to live with their elderly parents may also help interpret these findings. For example, elderly adults who transition into living with their adult offspring for health-related or economic reasons may have great difficulty in obtaining preventive care regardless of the presence of adult offspring. Adult offspring who live with their elderly parents may have characteristics that make them less able to provide assistance and resources to their parents in obtaining timely preventive care. Some adult offspring may even have characteristics that demand time and resources from elderly parents, thereby making access to preventive care more challenging. Although this study has provided some evidence that employed children may have difficulty in assisting an elderly parent to a doctor’s appointment for preventive care, further examination of intergenerational resource exchange and caregiver burden may explain these findings.
We also found that the prevalence of elderly adults getting colorectal cancer screenings and routine dental check-ups were generally low compared with other preventive services; these findings are consistent to previous studies.6
Reasons for low rates of colorectal cancer screening may be include patients’ concerns about painful procedures or stigma associated with this particular screening test. Low rates of routine dental check-ups may be attributed to the fact that these procedures are frequently not covered by health insurance, including Medicare. Furthermore, USPSTF recommendations currently have not established the appropriate age at which screenings should be discontinued. Clinical decisions about preventive screenings in older adults should take into account the potential costs and benefits of such tests to the patient.
There are limitations to this study. Data on preventive care use were self-reported and therefore subject to recall bias. Although there is evidence that supports the reliability of selfreported influenza vaccination21
and colorectal screening,22
evidence is mixed on the reliability of other self-reported preventive care services, especially those involving blood tests.23
Furthermore, although we examined general preventive care services that were captured in the MEPS for all individuals 65 years and older, other services could be investigated in future research, such as mammography screening for elderly women.
In addition, our analyses excluded elderly persons living with individuals other than their spouse and adult offspring, because elderly adults living in other household arrangements are an extremely heterogeneous group (e.g., living with nonrelatives or with children younger than 18 years) and constructing additional variables to capture this heterogeneity would result in insufficient sample sizes. Limiting our study sample therefore prevents us from extending the interpretation of our findings to elderly adults living in those arrangements that we have excluded from our sample.
Finally, because of the cross-sectional and nonexperimental design of this study, a causal relationship between household living arrangement and preventive care use cannot be assumed. Although we controlled for a number of potential confounders including a number of sociodemographic characteristics and health-status measures, our findings may be a reflection of some other underlying factors such as unmeasured functional or health status that may have affected both living arrangement and preventive care use. Unobserved factors that predispose adult offspring to live with their elderly parents or predispose elderly individuals to live with their adult offspring may prevent the elderly adult’s use of preventive care. Further research should investigate whether our findings are the results of causation or selection.
To our knowledge, ours is the first study to investigate the potential association between living arrangement and recommended preventive care. In doing so, our study can inform policies designed to improve the elderly population’s adherence to preventive care guidelines and make service delivery to this group more effective. Despite the limitations, we provide evidence that the prevalence of elderly adults’ adherence to recommended preventive care, especially colorectal cancer screenings and routine dental check-ups, remains below national goals. Preventive care should remain a priority among the elderly population, even among those with poor health, to guard against secondary diseases and promote overall health. In addition, our findings call attention to the importance of recognizing elderly adults’ living arrangement as an important factor for designing public health programs to improve preventive care use among the elderly population. Because the presence of adult offspring cannot be considered by default a resource for elderly individuals to obtain preventive care, educational and outreach interventions should target not only those elderly adults who live alone but also those living with adult offspring. Furthermore, research efforts should be taken to understand how elderly individuals benefit (or do not benefit) from living situations involving their adult offspring.