Disease prevention is treatment intended to prevent a disease from occurring or worsening. Disease prevention measures benefit independent older adults with minimal or no chronic disease and older adults 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 and lifestyle measures aimed to prevent common chronic diseases.
Immunizations that are recommended for most older adults include the following (1):
Lifestyle measures that are generally recommended for older adults to prevent chronic diseases include:
Healthy diet
Routine health screening
Social engagement
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 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 (eg, United States Preventive Services Task Force (USPSTF) publish screening guidelines, which sometimes differ from each other. Whatever a guideline recommends, individual patient characteristics and preferences must also be considered.
Cancer screening should be carefully considered and individual risk versus benefits should be weighed, particularly in patients with an estimated life expectancy ≤ 10 years. The following cancer screenings are generally recommended for older adults:
In addition, selected screenings for conditions that may affect older adults include:
Cognitive impairment (eg, dementia, delirium)
Thyroid dysfunction (hypothyroidism or hyperthyroidism)
Visual deficits
Primary and secondary prevention reference
1. U.S. Centers for Disease Control and Prevention. Recommended Vaccinations for Adults. Accessed June 12, 2025.
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 approximately half of people ≥ 65 (1). It leads to impaired mobility and increases risk of osteoporosis, aerobic and muscular deconditioning, falls, and pressure ulcers. Exercise and appropriate medications can aid in tertiary prevention (2).
Osteoporosis
Tests to measure bone density can detect osteoporosis before it leads to a fracture. A healthy diet, calcium and possibly vitamin D supplementation, exercise, and cessation of cigarette smoking can help prevent osteoporosis from progressing, and treatment can prevent new fractures.before it leads to a fracture. A healthy diet, calcium and possibly vitamin D supplementation, exercise, and cessation of cigarette smoking can help prevent osteoporosis from progressing, and treatment can prevent new fractures.
Diabetes
Hyperglycemia, especially when the glycosylated hemoglobin (HbA1C) concentration is elevated, increases the risk of retinopathy, neuropathy, nephropathy, and coronary artery disease (3). 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 for older patients can change based on additional factors (4):
< 7.5% for otherwise healthy diabetic older patients with a life expectancy of > 10 years
< 8.0% for patients with comorbidities and a reduced life expectancy
< 8.5% for frail patients with a markedly reduced 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 rates.
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.
Tertiary prevention references
1. Hawker GA, King LK. The Burden of Osteoarthritis in Older Adults. Clin Geriatr Med. 2022;38(2):181-192. doi:10.1016/j.cger.2021.11.005
2. Esbensen BA, Kennedy N, Brodin N. Prevention and adherence in Rheumatic and Musculoskeletal disease. Best Pract Res Clin Rheumatol. 2020;34(2):101525. doi:10.1016/j.berh.2020.101525
3. Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023;46(10):e151-e199. doi:10.2337/dci23-0036
4. Strain WD, Down S, Brown P, Puttanna A, Sinclair A. Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes. Diabetes Ther. 2021;12(5):1227-1247. doi:10.1007/s13300-021-01035-9
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
U.S. Preventive Services Task Force (USPSTF). 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.
Spalding MC, Sebesta SC. Geriatric screening and preventive care. Am Fam Physician. 2008;78(2):206-215
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