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Prevention in Older Adults

by James T. Pacala, MD, MS

The goals of prevention in an older adult usually depend on the person’s health, level of function, and risk profile, as for the following:

  • Healthy, independent people with no serious disorders: Mainly preventing disorders from developing

  • People who have several mild chronic disorders and who remain independent: Mainly preventing or slowing the decline in function and avoiding the physical deterioration that can make them increasingly dependent on others (called frailty, or decreased physical reserve)

  • Frail people who have several advanced chronic diseases and who have become mostly dependent on others: Mainly preventing accidents and complications that could cause further loss of independence or death

Lifestyle

Exercise , including aerobic exercise, is still important. Weight lifting helps protect against muscle weakness, age-related loss of muscle tissue, and osteoporosis by strengthening muscles and increasing bone density. Aerobic exercise increases endurance and may slightly lower the risk of some heart and blood vessel disorders. In older adults, dancing and tai chi, which can be enjoyable forms of exercise, may have additional benefits, such as enhancing balance and thus helping to prevent falls.

Stopping smoking is helpful at any age. It can

  • Help improve endurance

  • Decrease the frequency and severity of symptoms of certain disorders, such as chest pain (angina) and cramping, aching leg pain (claudication)

  • Decrease the risks of certain disorders developing (such as heart attacks)

Alcohol is metabolized differently in older adults. Older adults who drink alcohol need to be aware that more than one drink per day may increase their risk of injuries and other health problems.

Drugs and vaccines

Understanding drug therapy is particularly important for older adults because they are more susceptible to the side effects of drugs (see Aging and Drugs). Factors that can increase susceptibility include age-related differences in how the body processes (metabolizes) and uses many drugs. These differences can lead to interactions between drugs or between drugs and foods. These interactions may not occur in younger people.

A primary care doctor, nurse practitioner, and pharmacist can provide information on all prescription and nonprescription drugs. Knowing the brand and generic name of all drugs taken, each drug’s purpose, the length of time each drug is to be taken, and the activities, foods, drinks, and other drugs to be avoided while taking a drug can help older adults avoid problems. Older adults should bring all of their drugs, both prescription and nonprescription, to their doctor appointments so that these drugs can be reviewed with their doctor.

Older adults should get the following vaccines:

  • Pneumococcal vaccine (for pneumonia) once, unless the risk of developing pneumonia is high

  • Tetanus, diphtheria, and pertussis vaccine (a combination vaccine) once (if they have not previously received a pertussis vaccine) and then tetanus and diphtheria vaccine every 10 years

  • Flu (influenza) vaccine once a year

  • Shingles (herpes zoster) vaccine once at age 60

These vaccines are important because older adults are more susceptible to pneumonia, tetanus, and shingles and because influenza is more likely to lead to pneumonia and other severe problems in older adults.

Injury prevention

The same simple, common-sense safety measures that prevent injuries in younger adults are also useful for older adults (see Safety 101). Preventing falls is especially important.

Falls are a leading cause of serious health problems in older adults. The following can help prevent falls:

  • Cleaning up cluttered areas in the home

  • Removing or securing throw rugs, edges of carpet, and uncovered phone and electrical cords to the floor

  • Making sure lighting is adequate

  • Adding handrails, grab bars, and traction or nonskid surfaces (such as strips or nonslip bathmats) to stairways and bathtubs as needed

  • Installing handrails near the toilet and in the tub and shower

  • Not using slippery bath oils

  • Talking with the doctor about stopping any unnecessary drugs and making sure the lowest effective dose of needed drugs is being used

  • Preserving or improving balance (for example, through exercise, dance, or tai chi)

Driving

Older adults may have to limit or give up driving if their vision, reflexes, or overall function is poor. They should not drive when they are taking drugs that cause drowsiness, and they should not drive at night if their night vision is poor (see The Older Driver).