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

• Limit fat to less than 30% of calories (B)*
• Increase fiber (to 25 g) and calcium (to 1600 mg with Vitamin D) (B)
• Limit sodium (B)

Exercise

• Regular aerobic exercise for at least 30 minutes daily (B)

Tobacco use

• All smokers should be advised and offered assistance to quit (A)

Alcohol

• Use should be determined, education offered regarding special hazards for older persons, especially non-use during driving (B)

Immunizations

• Pneumonoccal vaccine should be given starting at age 65 and repeated in eight years, more often if potentially immunologically compromised (for example, diabetes mellitus) (B)
• Influenza vaccine annually (A)

Injury prevention

• Automobile seatbelts (A)
• Set hot water heater to <130°F (C)
• Fall prevention programs for all >75 years old and high risk groups (see Falls discussion)

Miscellaneous

• Inform women regarding hormone replacement (A)
• Encourage dental health (B)
• Offer CPR training for family (C)
• Use of sunglasses/hats (B)
• Sunscreen/protective clothing (C)
• Screening should be reviewed annually--can be done effectively by non-physicians (A):

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)

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.