• Lindsey C Yourman, Jaclyn Bergstrom, Elizabeth A Bryant, Alina Pollner, Alison A Moore, Nancy Li Schoenborn, and Mara A Schonberg.
• Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, CA, USA. LindseyC.Yourman@sdcounty.ca.gov.
• J Gen Intern Med. 2024 Feb 1; 39 (3): 440449440-449.

ImportanceThe likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult's life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit.ObjectiveTo examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy.DesignAnalysis of 2019 National Health Interview Survey.Participants8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults.Main MeasuresProportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors.Key ResultsOverall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination.ConclusionsDespite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults' life expectancy may improve care of older adults.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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