title: Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States.
abstract: OBJECTIVE
  The presence of psychologic distress in older adults may be associated with decreased adherence to recommended preventive-care services. This analysis aimed to measure the association between psychologic distress and adherence to United States Preventive Services Task Force (USPSTF)-recommended preventive-care services among older adults in the United States.
  
  
  METHODS
  We undertook a cross-sectional analysis of 3655 U.S. community-dwelling elderly from the 2001 Medical Expenditure Panel (MEPS) survey.
  
  
  METHODS
  The presence of psychologic distress was captured by the Mental Component Survey (MCS) of the SF-12. The receipt of 9 preventive care services were captured using MEPS: hypertension screening, influenza vaccination, fecal occult blood testing or sigmoidoscopy, mammography, clinical breast examination, cholesterol screening, prostate-specific antigen test, routine check-up, and dental checkup.
  
  
  RESULTS
  Elderly reporting psychologic distress were 30% less likely than nondistressed elderly to receive influenza vaccination (OR = 0.70, 95% CI = 0.55-0.88) and 23% less likely to receive annual dental check-ups (OR= 0.77, 95% CI = 0.61-0.97). Women with psychologic distress were 27% less likely to receive a clinical breast examination (OR = 0.73, 95% CI = 0.57-0.94). Psychologic distress was not significantly associated with screening for hypertension, colon cancer, high cholesterol, or prostrate cancer, mammography, or routine check-ups.
  
  
  CONCLUSIONS
  Elderly reporting psychologic distress were less likely to adhere to some, but not all, recommended preventive care guidelines. These results suggest that adherence to recommended preventive care guidelines may be improved, indirectly, by improving recognition and treatment of emotional health problems in the elderly.
authors.affiliation: Department of Pharmaceutical Policy and Evaluative Sciences, University of North Carolina at Chapel Hill School of Pharmacy, USA. joshua.thorpe@duke.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Kalinowski
authors.forename: Mark E
authors.initials: ME
authors.lastname: Patterson
authors.forename: Betsy L
authors.initials: BL
authors.lastname: Sleath
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology*; D014481:United States