For older adults, prevention focuses mainly on preventing disease, frailty, accidents (ie, unintentional injury), iatrogenic complications, and psychosocial problems and on maintaining the ability to perform activities of daily living. Not all older patients benefit from every preventive measure. Choice of preventive measures is guided by whether the patient’s general condition is
Healthy
Chronically ill
Frail and/or complex
Healthy older people have minimal or no chronic disease and are functionally independent. Primary and secondary prevention of disease Primary and Secondary Prevention 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... read more and prevention of frailty Prevention of Frailty Frailty is loss of physiologic reserve, which makes people susceptible to disability due to minor stresses. Common features of frailty include weakness, slowed motor function, weight loss, muscle... read more are the most beneficial measures for this group.
Chronically ill people typically have several noncurable but treatable diseases, are usually functionally independent or minimally dependent, often take several prescription medications, and occasionally are hospitalized for exacerbations of their chronic diseases. Secondary Primary and Secondary Prevention 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... read more and tertiary prevention of disease Tertiary Prevention 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... read more and prevention of frailty Prevention of Frailty Frailty is loss of physiologic reserve, which makes people susceptible to disability due to minor stresses. Common features of frailty include weakness, slowed motor function, weight loss, muscle... read more are priorities, as are primary prevention of disease Primary and Secondary Prevention 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... read more and prevention of iatrogenic complications Prevention of Iatrogenic Complications in Older Adults Iatrogenic complications are more common and often more severe among older adults than among younger patients. These complications include adverse drug effects (eg, interactions), falls, nosocomial... read more and accidents.
Chronically ill patients and their caregivers should learn about their diseases and treatment plans. 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.
Frail and/or complex 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.
Caregivers of frail older adults 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 older patients and promptly report any changes to a health care professional. 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.
General preventive measures
Some preventive measures that apply to all older people include
Diet Nutritional Requirements Good nutrition aims to achieve and maintain a desirable body composition and high potential for physical and mental work. Balancing energy intake with energy expenditure is necessary for a desirable... read more and exercise Exercise in Older Adults At least 75% of people age > 65 years do not exercise at recommended levels despite the known health benefits of exercise: Longer survival Improved quality of life (eg, endurance, strength... read more : A healthy diet (see table ) and regular exercise help prevent or postpone frailty and many diseases, as can other lifestyle measures (see table ). For example, exercise can help prevent frailty and enhance functional ability in healthy or chronically ill older people. Exercise can help people who are frail preserve functional ability and reduce the incidence of accidents.
Screening and prevention Physical Examination of the Older Adult The physical examination of the older adult should include all major systems but with particular attention to areas of concern identified during the history (see also Overview of Evaluation... read more : Healthy older people should visit their primary care physician at least annually to ensure timely implementation of primary and secondary disease prevention measures, including screenings (see tables and ) and chemoprevention (eg, vaccination—see table ). Influenza vaccination (yearly) and an appropriate type of pneumococcal vaccination Pneumococcal Vaccine Pneumococcal disease (eg, otitis media, pneumonia, sepsis, meningitis) is caused by some of the > 90 serotypes of Streptococcus pneumoniae (pneumococci). Vaccines are directed against... read more are effective, inexpensive, and associated with minimal morbidity (see also Centers for Disease Control and Prevention: Pneumococcal Vaccination). Medicare covers a comprehensive “Welcome to Medicare” preventive physical examination, which must occur within 12 months of Part B enrollment, and an annual wellness visit every 12 months thereafter.
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.
