Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3045 — Relationship of Health Status and Screening PSA among Elderly Veterans

Author List:
Walter LC (San Francisco VAMC)
Bertenthal D (San Francisco VAMC)

Objectives:
Unhealthy elderly men with a life expectancy < 10 years are more likely to be harmed by prostate-specific antigen (PSA) screening than to benefit. Therefore, this study was conducted to determine whether PSA screening is performed mostly in healthy elderly veterans and avoided in unhealthy elderly veterans with limited life expectancies.

Methods:
A longitudinal study of 845,679 men aged 70 and older seen at 104 VA facilities 10/1/02-9/30/03 (FY2003) who did not have a history of prostate cancer, elevated PSA, or prostate symptoms. The main outcome was receipt of PSA testing during FY2003 based on VA laboratory data and Medicare claims. Health status was measured by the Charlson-Deyo index using VA and Medicare claims 10/1/00-9/30/02. Charlson scores were used to stratify older men into 3 groups, ranging from best health (score = 0) to worst health (score >= 4).

Results:
Mean age was 77 years; 6% were black. 55% of elderly veterans had a PSA test in FY2003 (73% of screened veterans had at least one PSA test within VA, 39% within Medicare, and 12% in both). PSA rates decreased with advancing age, ranging from 63% in men aged 70-74 to 27% in men aged 90 years or more (P<0.001). However, within each age group the percentage of men with a PSA test did not significantly decline with worsening health. For example, among men aged 80-84, 43% in best health had a PSA test compared with 44% in the worst health (P>0.1). Although men aged >=80 years in the worst health have less than a 10% chance of living 10 years, 21,236 (42%) of such veterans had a PSA test during FY2003.

Implications:
Rates of PSA screening are high among elderly veterans, with the majority of tests occurring within VA. Screening PSA is not avoided by elderly veterans in poor health, who have limited life expectancies.

Impacts:
Quality of care could be improved by better targeting PSA screening based on life expectancy. PSA screening should be reduced in elderly veterans with limited life expectancies for whom the known risks of screening outweigh the low likelihood of benefit.