Preventive Healthcare for Older Populations

James R. Webster Jr., M.S., M.D.

 

Although preventive geriatrics sounds like an oxymoron, it actually is one of the most effective interventions that physicians can undertake to increase not only the lifespan of their patients but more importantly their functional status. Unlike strategies for younger populations, prevention in the elderly has immediate positive impact and is very cost effective. The data is now quite compelling that all patients > 65 years old should be provided with primary preventive care, although this need not be done by physicians. It may utilize written approaches and should include:

Diet counseling

Exercise

Tobacco use

Alcohol

Immunizations

Injury prevention

*Letters A, B, and C refer to level of evidence.
A=randomized controlled trials, B=well conducted clinical studies, C=expert opinion.

Miscellaneous

For average risk population

Blood pressure annually (A)
Height and weight annually (B)
Mobility assessment (B) (see falls discussion)
Fecal occult blood annually (B)
Sigmoidoscopy every five years (B)
Mammogram and clinical breast exam annually (A)
Pap tests every three years until three completely normal (B)
Vision and hearing screening (A)
Assess for problem drinking (B)
Assess for functional status (B)
Thyroid function test in women (C)
Review medications including OTC's (A)

For high risk population

Cardiovascular disease risk
Consider lipid evaluation (B)
Review aspirin prophylaxis (B)
Colo-rectal cancer--more frequent sigmoidoscopy or colonoscopy (B)
Abdominal aortic aneurysm screening by palpation or ultrasound, auscultation for carotid bruits (C)
Two step PPD for institutionalized elderly (A)
Depression screening (see Depression discussion) (B)
Cognitive decline (see Dementia discussion) (B)

References

1. Patterson C, Chambers LW. Preventive health care. Lancet 1995;345:1611-15. [Citation]

2. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Alexandria, VA. International Medical Publishers, 1996.




Copyright ©1999. Northwestern University. All Rights Reserved.
Edited by the Buehler Center on Aging, McGaw Medical Center.
For information regarding content contact:
James R. Webster, j-webster@northwestern.edu

Published electronically by the Galter Health Sciences Library.
For information regarding publication contact:
James Shedlock, j-shedlock@northwestern.edu

Last Updated: June 9, 1999