Preventive care of older urban American Indians and Alaska Natives in primary care

Little is known about prevention among elderly or urban American Indian/Ala ska Native (AI/AN) populations. We reviewed the medical records of 550 olde r urban AI/AN primary care patients to evaluate how frequently preventive m easures were received. Adherence to guidelines was examined by a culturally appropriate (greater than or equal to 50 years) and standard age threshold (greater than or equal to 65 years), and by performance of preventive meas ures at any time ("ever") and in the past year. Lifetime performance was in adequate for the many measures, including mammograms (56%), fecal occult bl ood testing (37%). audiometry (33%), visual acuity testing (50%), smoking c essation counseling (50%), and pneumococcal (22%) and influenza (49%) vacci nations. Performance of the measures was less frequent in the prior year, b ut did not differ by age threshold. predictors of adherence included female gender, having insurance, and having more health problems and medications. Nonadherence Infrequently resulted from patients' failure to comply with r ecommendations. We conclude that use of most preventive services among elde rly urban AI/ANs is suboptimal and should be improved.