Engage, deliver and follow up: Community-based interventions to increase the use of clinical preventive services by older adults

Many older adults are not using the full set of clinical preventive services (CPS) that have been proven effective (such as influenza immunizations, and screening for breast or colorectal cancer). Rates of utilization are particularly low among racial and ethnic minority elderly, contributing to health disparities. We report on a CDC-funded systematic review of the published literature which identified evidence-based programs delivered in the community to increase the uptake of CPS by older adults. Search criteria included programs that served adults age 50 and older and demonstrated positive outcomes. Programs of particular interest included “bundled” CPS interventions, which improved efficiency by delivering two or more CPS to underserved populations.  We identified 216 articles, representing 142 model programs of which 38 were “bundled.” Programs were independently reviewed and rated by an external expert panel and by the research team. Following a check for inter-rater reliability, a final set of 20 programs was determined to meet our threshold for level of evidence. The majority of these programs focused on underserved minority populations (14/20). Programs were delivered in a broad range of community settings including churches, pharmacies, schools, community centers and nonprofit organizations. Approaches used to engage, deliver, and follow up with the provision of CPS to older adults included educational, behavioral, instrumental, navigational, referral and linkage strategies. While there are gaps in the evidence base that need to be addressed, these programs begin to build a body of evidence for effective ways to increase the uptake of CPS by older adults.