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Prevention of Disease in Older Adults

By

Magda Lenartowicz

, MD, Trinity Hospice, Los Angeles

Last full review/revision Oct 2020| Content last modified Oct 2020
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Topic Resources

Disease prevention is treatment intended to prevent a disease from occurring or worsening. Independent, older people with minimal or no chronic disease, as well as older people with several noncurable but treatable diseases, benefit from disease prevention measures.

Primary and Secondary Prevention

Secondary prevention aims to detect and treat disease or its complications at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality.

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Screening

Screening references

  • 1. Jellinger PA, Handelsman Y, Rosenblit PD, et al: American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dysipidemia and Prevention of Cardiovascular Disease. Endocrine Practice 23:1-87, 2017. doi:10.4158/EP171764.APPGL

  • 2. American Diabetes Association: Standards of medical care in diabetes. Diabetes Care 43(Supplement 1): S1-S2, 2020. https://doi.org/10.2337/dc20-Sint

Tertiary Prevention

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 older adults, can potentially benefit from tertiary prevention.

Arthritis

Osteoporosis

Diabetes

Hyperglycemia Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , especially when the glycosylated hemoglobin (HbA1C) concentration is > 7.9% for at least 7 years, increases the risk of retinopathy Diabetic Retinopathy Manifestations of diabetic retinopathy include microaneurysms, intraretinal hemorrhage, exudates, macular edema, macular ischemia, neovascularization, vitreous hemorrhage, and traction retinal... read more Diabetic Retinopathy , neuropathy Diabetic Neuropathy In patients with diabetes mellitus, years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular)... read more Diabetic Neuropathy , nephropathy Diabetic Nephropathy In patients with diabetes mellitus, years of poorly controlled hyperglycemia lead to multiple, primarily vascular, complications that affect small vessels (microvascular), large vessels (macrovascular)... read more Diabetic Nephropathy , and coronary artery disease Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more Overview of 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

  • < 7.5% for otherwise healthy diabetic older patients with a life expectancy of > 10 years

  • < 8.0% for patients with comorbidities and a life expectancy of < 10 years

  • < 9.0% for frail patients with a limited life expectancy

Control of hypertension and dyslipidemia in diabetic patients is particularly important.

Patient education and foot examinations at each visit can help prevent foot ulcers.

Vascular disorders

Heart failure

Morbidity due to heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid... read more Heart Failure (HF) is significant among older adults, and the mortality rate is higher than that of many cancers. Appropriate, aggressive treatment, especially of systolic dysfunction, reduces functional decline, hospitalization, and mortality rate.

Chronic obstructive pulmonary disease (COPD)

Smoking cessation, appropriate use of inhalers and other drugs, and patient education regarding energy-conserving behavioral techniques can decrease the number and severity of exacerbations of COPD Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. Alpha-1 antitrypsin deficiency and various occupational... read more Chronic Obstructive Pulmonary Disease (COPD) leading to hospitalization.

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