Prevention of Disease in the Elderly
Primary prevention aims to stop disease before it starts, often by reducing or eliminating risk factors. Primary prevention may include immunoprophylaxis (vaccinations), chemoprophylaxis (Chemoprevention and Immunization for Elderly Patients), and lifestyle changes (see Lifestyle Measures That Help Prevent Common Chronic Diseases). In secondary prevention, disease is detected and treated at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality.
Screening can be a primary or secondary preventive measure. Screening can be used to detect risk factors, which may be altered to prevent disease, or to detect disease in asymptomatic people, who can then be treated early.
Chemoprevention and Immunization for Elderly Patients
Lifestyle Measures That Help Prevent Common Chronic Diseases
Screening Recommendations for Elderly Patients
Cancer Screening Recommendations for Elderly Patients
In tertiary prevention, an existing symptomatic, usually chronic disease is appropriately managed to prevent further functional loss. Disease management is enhanced by using disease-specific practice guidelines and protocols. Several disease management programs have been developed:
Disease-specific care management: A specially trained nurse, working with a primary care physician or geriatrician, coordinates protocol-driven care, arranges support services, and teaches patients.
Chronic care clinics: Patients with the same chronic disease are taught in groups and are visited by a health care practitioner; this approach can help patients with diabetes achieve better glucose control.
Specialists: Patients with a chronic disease that is difficult to stabilize can be referred to a specialist. This approach works best when the specialist and primary care physician work collaboratively.
Patients with the following chronic disorders, which are common among the elderly, can potentially benefit from tertiary prevention.
Hyperglycemia, especially when the glycosylated hemoglobin (Hb A1c) concentration is > 7.9% for at least 7 yr, increases the risk of retinopathy, neuropathy, nephropathy, and coronary artery disease. Glycemic treatment goals should be adjusted based on patient preferences, comorbid conditions, and life expectancy. For example, appropriate HbA1c goals might be
Control of hypertension and dyslipidemia in diabetic patients is particularly important.
Patient education and foot examinations at each visit can help prevent foot ulcers.
Elderly patients with a history of coronary artery disease, cerebrovascular disease, or peripheral vascular disease are at high risk of disabling events. Risk can be reduced by aggressive management of vascular risk factors (eg, hypertension, smoking, diabetes, obesity, atrial fibrillation, dyslipidemia).