摘要：Objectives. We sought to examine the relationship between living arrangements and obtaining preventive care among the elderly population. Methods. We obtained data on 13 038 community-dwelling elderly persons from the 2002 to 2005 Medical Expenditure Panel Survey and used multivariate logistic regression models to estimate the likelihood of preventive care use among elderly persons in 4 living arrangements: living alone (38%), living with one's spouse only (52%), living with one's spouse and with one's adult offspring (5%), and living with one's adult offspring only (5%). Preventive care services included influenza vaccination, physical and dental checkup, and screenings for hypertension, cholesterol, and colorectal cancer. Results. After we controlled for age, gender, race, education, income, health insurance, comorbidities, self-reported health, physical function status, and residence location, we found that elderly persons living with a spouse only were more likely than were those living alone to obtain all preventive care services, except for hypertension screening. However, those living with their adult offspring were not more likely to obtain recommended preventive care compared with those living alone. These results did not change when the employment status and functional status of adult offspring were considered. Conclusions. Interventions to improve preventive care use should target not only those elderly persons who live alone but also those living with adult offspring. Ensuring the timely use of preventive care services among adults who are 65 years and older is a public health priority as the elderly population in the United States continues to grow. Strong evidence indicates that annual influenza vaccination and early detection of certain conditions such as hypertension, hypercholesterolemia, heart disease, and many forms of cancers are effective in reducing mortality and associated disability among elderly men and women. 1 , 2 Based on the strength of scientific evidence and the net benefit assessment of various preventive health services, the United States Preventive Services Tasks Force (USPSTF) has developed recommendations on clinical preventive care that include screening tests, counseling, and preventive medications for adults 65 years and older. 3 Unfortunately, adherence to USPSTF recommendations is below expectation, and the available research documents wide variation in preventive service use. Prior studies have documented variation in preventive care use by sociodemographic characteristics such as race/ethnicity, education, and income, 4 , 5 as well as health-related factors including health status, psychological distress, and health beliefs. 6 , 7 Other studies have examined community characteristics including urban versus rural status, racial/ethnic composition, and median income level. 8 , 9 One important factor that has not been studied but may influence preventive care use among the elderly population is living arrangement—cohabitation with other individuals in a household unit. The United Nations has identified living arrangements of older persons as one of the most pressing concerns of the aging population. 10 About 1 in 3 community-dwelling elderly persons 65 years or older, and 1 in 2 aged 80 years and older, live alone in the United States. 11 Previous studies found that elderly persons living alone are more likely to use publicly subsidized home care services to meet instrumental activities of daily living (IADL). 12 In addition, some evidence suggests that with all else being equal, living arrangement may be better than marital status at predicting health services use, including physician office visits. 13 Given these findings, it is reasonable to expect that living arrangements may be related to elderly persons' use of preventive care according to USPSTF recommendations. Because elderly persons' living arrangement can be considered a proxy measure of family-related resources for accessing preventive services, we hypothesized that even after we controlled for health and other characteristics, community-dwelling elderly men and women who live alone would be less likely to adhere to recommended preventive care than would elderly men and women who live with their spouse, children, or both.
