Women are living longer than ever. A woman who is 65 today can, on average, expect to live another 19 years to age 84. Despite recognition of the essential role preventive care and healthy habits play in these later years, older women and their physicians often miss opportunities to promote good health.

This is the conclusion of the Commonwealth Fund report by Karen Scott Collins and Erin Strumpf titled Living Longer, Staying Well: Promoting Good Health for Older Women. Excerpts of the report include the following:

Heart disease remains the leading cause of mortality for older women. Among women in the Commonwealth Fund survey, 21 percent of women age 65 and older reported they had suffered a heart attack or had been diagnosed with heart disease in the past five years, compared with only 6 percent of women age 45 to 64. These numbers make a clear case that screening and other preventive care must continue after age 65.

A comparison of findings from the Fund's 1993 and 1998 women's health surveys conducted by Louis Harris and Associates, Inc. show a general lack of improvement in receipt of preventive services during the intervening five years. Although there was a small improvement in the percentage of women age 65 and older who received clinical breast exams and mammograms, the percentage of women receiving a Pap test declined.

The proportion of older women who said they were very familiar with osteoporosis increased as did the percentage of women taking calcium supplements. The success achieved in osteoporosis prevention illustrates the central importance of public education and physician counseling.

Annual physicals are another important component of preventive care, especially as a means of identifying early signs of heart disease and other chronic conditions in older women. Yet only two-thirds (66%) of women age 65 and over had a complete physical exam in the past year.

Medicare now covers annual mammograms without cost to beneficiaries. However, physician services and preventive services, including Pap tests, remain subject to patient cost-sharing. The financial barriers that cost-sharing creates may contribute to the lower rate of preventive care among lower income older women. Moreover, the exclusion of prescription drugs from Medicare coverage can also affect use of medications that lower the risk of osteoporosis: only one of five older women with incomes below $35,000 receives hormone replacement therapy, compared with two of five with incomes above $35,000.

In addition to clinical screening services, counseling and education are also vital components of preventive care. The 1998 survey found considerable room for improvement on these measures. Just half of older women reported that their doctor discussed with them diet and weight, exercise, or the importance of calcium intake.

Elderly women with lower incomes are at greater risk for poor health and disability than those with higher incomes - and nearly 70 percent of women over age 65 have yearly incomes of $35,000 or less. While chronic conditions are already quite high for women in the 65-and-older age group, lower-income older women have significantly higher rates of hypertension and diabetes. These women are also more than twice as likely to rate their own health as fair or poor.

Lower-income older women are much more dependent on the adequacy of Medicare benefits. More than one of five (22%) have no supplemental coverage to pick up their share of Medicare premiums or to help pay for services that Medicare does not cover. Only half, meanwhile, have private supplemental coverage through a retiree health plan, MediGap policy, or managed care plan.

Summary and Recommendations

Assuring that older women receive preventive services must be a continuing priority for health care providers, policymakers, and consumer health advocates -- as well as for women and their families. Chronic conditions, physical limitations, and the risk of cancer and heart disease all increase as women age, making preventive screening and care a key part of their health care.

Removing financial barriers to preventive and primary care is an important first step in promoting better health and well-being among older women of all incomes levels. As the role of pharmaceutical drugs in caring for the elderly continues to expand, helping Medicare beneficiaries afford prescribed medications is crucial as well. The Medicare program could also more actively promote the use of essential preventive care services through its quality standards for managed care plans and its beneficiary education efforts.

Physicians need to take greater responsibility, too. Doctors should urge women to get regular preventive care. They must also provide counseling to patients about their options for improving health and reducing the risk of chronic illness. Because older women are more likely to rely on one physician for their care rather than two, doctors need to take full advantage of their time spent with patients; a missed opportunity for preventive care will not be "made up" somewhere else.

More comprehensive insurance coverage and greater awareness of the value of preventive care among doctors and patients will help improve women's health and, ultimately, enjoyment of life in their later years.

A full copy of the report may be obtained by calling 1-888-777-2744 or online at www.cmwf.org.