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 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 medications, 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 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 and exercise: A healthy diet (see table Nutritional Recommendations) and regular exercise help prevent or postpone frailty and many diseases, as can other lifestyle measures (see table Lifestyle Measures That Help Prevent Common Chronic Diseases). 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: 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 Selected Screening Recommendations for Older Patients and Cancer Screening Recommendations for Older Patients) and chemoprevention (eg, vaccination—see table Chemoprevention and Immunization for Older Patients). Influenza vaccination (yearly) and an appropriate type of pneumococcal vaccination 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.
