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Overview of Prevention in the Elderly

By James T. Pacala, MD, MS, Professor and Associate Head, Department of Family Medicine and Community Health, University of Minnesota Medical School

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For the elderly, prevention focuses mainly on disease, frailty, accidents (ie, unintentional injury), iatrogenic complications, and psychosocial problems. Not all elderly patients benefit from every preventive measure. Choice of preventive measures is guided by the patient’s general condition:

  • Healthy: These elderly people have minimal or no chronic disease and are functionally independent. Primary and secondary prevention of disease and prevention of frailty are the most beneficial measures for this group.

  • Chronically ill: These people typically have several noncurable but treatable diseases, are usually functionally independent or minimally dependent, often take several prescription drugs, and occasionally are hospitalized for exacerbations of their chronic diseases. Secondary and tertiary prevention of disease and prevention of frailty are priorities, as are primary prevention of disease and prevention of iatrogenic complications and accidents.

  • Frail/complex: These people typically have many severe chronic diseases, are functionally dependent, and have lost their physiologic reserve. They are frequently hospitalized and institutionalized. For them, prevention of accidents and iatrogenic complications is most important.

Some preventive measures apply to all elderly people. For example, exercise can help prevent frailty in healthy or chronically ill elderly people. In frail elderly people, exercise can help preserve functional ability and reduce the incidence of accidents. Influenza vaccination (yearly) and pneumococcal vaccination (needed only once, except for patients at high risk) are effective, inexpensive, and associated with minimal morbidity.

Patient and caregiver issues

Healthy elderly people should visit their primary care physician at least annually to ensure timely completion of primary and secondary disease prevention measures, including screening ( Screening Recommendations for Elderly Patients and see Table: Cancer Screening Recommendations for Elderly Patients) and chemoprevention (eg, vaccination, aspirinChemoprevention and Immunization for Elderly Patients). For more information, see recommendations for clinical preventive services from the U.S. Preventive Services Task Force (USPSTF).

Medicare covers a comprehensive “Welcome to Medicare” preventive physical examination, which must occur within 12 mo of Part B enrollment, and an annual wellness visit every 12 mo thereafter.

Regular exercise (see Exercise in the Elderly) and a healthy diet (see Nutritional Recommendations for Prevention of Frailty) help prevent or postpone frailty and many diseases, as can other disease prevention measures (see Lifestyle Measures That Help Prevent Common Chronic Diseases). Chronically ill patients should learn about their diseases and treatment plans, as should their caregivers. Regular physician visits and prompt reporting of a change in symptoms can help reduce severe disease exacerbations, which can lead to hospitalization and functional decline.

Caregivers of the frail elderly must work assiduously to prevent accidents by completing a home safety checklist and correcting any potential problems that are identified. Caregivers should watch for even subtle functional changes in elderly patients and promptly report any changes to a health care practitioner. If a patient has multiple unmet needs, especially when coupled with functional decline, a caregiver should consider seeking the care of a geriatric interdisciplinary team.