Disease prevention is treatment intended to prevent a disease from occurring or worsening. Disease prevention measures benefit independent older people with minimal or no chronic disease and older people with several noncurable but treatable diseases.
Primary and Secondary Prevention
Primary prevention aims to stop disease before it starts, often by reducing or eliminating risk factors. Primary prevention may include immunoprophylaxis (vaccinations), chemoprophylaxis (see table Chemoprevention and Immunization for Older Patients ), and lifestyle changes (see table Lifestyle Measures That Help Prevent Common Chronic Diseases).
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.
Screening
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.
Multiple organizations publish screening guidelines, which sometimes differ. Whatever a guideline recommends, individual patient characteristics and preferences must also be considered. Guidelines for cancer screening and screening for certain other disorders (eg, abdominal aortic aneurysm, elder abuse, depression) are available.
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 Dyslipidemia and Prevention of Cardiovascular Disease. Endocrine Practice 23 (4):479–497, 2017. doi:10.4158/EP171764.APPGL
2. Arnett DK, Blumenthal RS, Albert MA, et al: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation140 (11):e596–e646, 2019. doi: 10.1161/CIR.000000000000067
3. American Diabetes Association: Introduction: Standards of medical care in diabetes—2020. Diabetes Care 43 (Supplement 1): S1–S2, 2020. https://doi.org/10.2337/dc20-Sint
4. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society: Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157, 2011.
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 professional; 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
Arthritis (primarily osteoarthritis; much less commonly, rheumatoid arthritis) affects about half of people ≥ 65. It leads to impaired mobility and increases risk of osteoporosis, aerobic and muscular deconditioning, falls, and pressure ulcers.
Osteoporosis
Tests to measure bone density can detect osteoporosis
Diabetes
Hyperglycemia, especially when the glycosylated hemoglobin (HbA1C) concentration is > 7.9% for at least 7 years, increases the risk of retinopathy, neuropathy, nephropathy, and coronary artery disease. Glycemic treatment goals should be adjusted based on patient preferences, duration of diabetes, comorbid conditions, vascular complications, risks related to hypoglycemia, concomitant medications, and life expectancy. For most adults ,an HbA1C goal of < 7% without significant hypoglycemia is appropriate. However, appropriate HbA1C goals can change based on additional factors:
< 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
Older 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).
Heart failure
Morbidity due to heart failure 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 medications, and patient education regarding energy-conserving behavioral techniques can decrease the number and severity of exacerbations of COPD leading to hospitalization.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
U.S. Preventive Services Task Force (USPSTF) Published Recommendations: The U.S. Preventive Services Task Force publishes recommendations for screening and preventive strategies for specific conditions, based on a systematic review of the evidence.
