For older adults, prevention focuses mainly on disease, frailty, accidents (ie, unintentional injury), iatrogenic complications, psychosocial problems, and maintaining 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 older people have minimal or no chronic disease and are functionally independent. Primary and secondary prevention of disease and prevention of frailty 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 drugs, and occasionally are hospitalized for exacerbations of their chronic diseases. Secondary and tertiary prevention of disease and prevention of frailty are priorities, as are primary prevention of disease and prevention of iatrogenic complications and accidents.
Chronically ill patients should learn about their diseases and treatment plans, as should their caregivers. 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/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 practitioner. 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.
Some preventive measures that apply to all older people include
Diet and exercise: A healthy diet (see Table: Nutritional Recommendations for Prevention of Frailty) and regular exercise help prevent or postpone frailty and many diseases, as can other disease prevention measures (see Table: Lifestyle Measures That Help Prevent Common Chronic Diseases). For example, exercise can help prevent frailty in healthy or chronically ill older people. In those who are frail, exercise can help preserve functional ability and reduce the incidence of accidents.
Screening and prevention: Healthy older people should visit their primary care physician at least annually to ensure timely completion of primary and secondary disease prevention measures, including screenings (see Table: Selected Screening Recommendations for Older Patients and see Table: Cancer Screening* Recommendations for Older Patients) and chemoprevention (eg, vaccination, aspirin—see Table: Chemoprevention and Immunization for Older Patients). Influenza vaccination (yearly) and pneumococcal vaccination PPSV23 and, in older people with certain medical conditions, PCV13 as well 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.