This topic carries a lot of importance in care of elderly and awareness regarding the steps goes a long way to prevent both morbidity and mortality in elderly.
Prevention of disease in elderly falls in 3 broad categories:
PRIMARY PREVENTION It aims to stop disease before it starts, often by reducing or eliminating risk factors. May include immunoprophylaxis ( vaccinations), chemoprevention and lifestyle changes.
Disease to be prevented Measure Frequency Comments
Coronary Artery Disease, Aspirin chemoprophylaxis Daily For adults 60-69 years age ,
stroke decision based on
individualized risk/ benefit
assessment For adults ≥
70 , insufficient evidence .
Low dose 81mg of aspirin
recommended
Influenza Influenza vaccination Yearly Recommended for
everyone
Pneumococcal infection Pneumococcal vaccination Twice For everyone ≥ 65 years
:recommendation for 13
valent pneumococcal
conjugate vaccine ( PCV
13) followed by 23 valent
pneumococcal
polysaccharide vaccine (
PPSV23) at least 1 year
after PCV 13
Tetanus Tetanus vaccination Every For everyone ≥ 65 ,
10 yrs recommendation for a
tetanus and diphtheria
toxoids (dT) booster every
10 years or,if people were
never vaccinated , to be
given the primary 3-
dose vaccine series.Patients
who never received
Tdap+should receive 1 dose
of that preparation
Zoster Zoster vaccination Once or For everyone ≥ 60, twice at vaccination twice age 60 regardless of history of zoster or varicella
Tdap- Diptheria (D) vaccine contains toxoids prepared from Corynebacterium diphtheriae, Tetanus (T)vaccines contains toxoids prepared from Clostridium tetani. Acellular(a) pertusis (P) vaccines contain
semi purified or purified components of Bordetella pertussis.
Lifestyle Measures That Help Prevent Common Chronic Diseases
Measure - Smoking cessation
Examples of Diseases - Atherosclerotic cardiovascular disease (coronary artery disease, stroke), cancer,COPD, diabetes mellitus type 2, hypertension,
osteoporosis
Measure - Achievement of and maintainenance of a desirable body weight
Examples of Diseases- Atherosclerotic cardiovascular disease (coronary artery disease,
stroke), diabetes mellitus type 2, hypertension, osteoarthritis
Measure- Reduction of dietary saturated fat and avoidance of trans fats
Examples of Disease- Atherosclerotic cardiovascular disease (coronary artery disease,
stroke), cancer,diabetes mellitus type 2, hypertension
Measure - Increased intake of fruits, vegetables, and fiber
Examples of Disease- Atherosclerotic cardiovascular disease (coronary artery disease,
stroke), cancer(possibly), hypertension
Measure- Increased aerobic exercise
Examples of Disease- Atherosclerotic cardiovascular disease (coronary artery disease,
stroke), cancer
Measure- Reduction of dietary Na
Examples of Disease- Atherosclerotic cardiovascular disease (coronary artery disease,
stroke),hypertension
Measure- Reduced intake of salt- or smoke cured food
Examples of Disease- Cancer
Measure- Minimized radiation and sun exposure
Examples of Disease- Cancers
Measure- Muscle strengthening and stretching
Examples of Disease- Osteoarthritis
Measure- Moderate physical activity
Examples of Disease- Osteoarthritis
Measure- Adequate Ca and vitamin D intake and sun
exposure
Examples of Disease- Osteoporosis
Measure- Regular weight-bearing exercise
Examples of Disease- Osteoporosis
Measure- Limited caffeine intake
Examples of Disease- Osteoporosis
Measure- Limited alcohol intake (to 1 drink/day)
Examples of Disease- Cirrhosis of the liver, osteoporosis
Screening
Screening can be a primary or secondary preventive measure. Screening can be usedto detect risk factors, which may be altered to prevent disease, or to detect disease in asymptomatic people, who can then be treated early.
Selected Screening Recommendations for Elderly Patients
Disease to Be Detected Test Frequency
Abdominal aortic aneurysm Abdominal ultrasonography Once between age 65–75
Abuse or neglect Inquire about mistreatment At least once
(eg "Are there any problems
with family or household members
that you would like to tell me
about?")
Alcohol misuse Alcoholism screening questionnaire At least once
ASCVD (atherosclerotic Framingham criteria,Reynolds Annually
cardiovascular disease) Risk Score (only up to age 80),
Multi-ethnic study of atherosclerosis
(MESA)—up to age 85
Cognitive impairment Cognitive impairment
(eg, dementia, delirium) screening instrument
(eg, Mini-Cog)
Depression Depression screening questionnaire Yearly
(major depressive disorder) (eg, PHQ-2)
Diabetes mellitus, type 2 Fasting plasma glucose level Yearly
Fall risk Inquiry about falls during the previous Yearly
year and about difficulty with walking
or balance, Get-Up-and-Go test
Glaucoma Intraocular pressure measurement Yearly
Hearing deficits Bedside hearing test Yearly
HIV HIV test of serum, blood, or oral fluid At least once
Hypertension BP measurement At least every 2 yr for people
with BP <120/80 mmHg
Annually for people with
higher BP and/or risk factors
(eg, overweight or obese,
sedentary, strong family
history, African-
American)
Obesity or Height and weight measurement At least yearly
undernutrition BMI (kg/m2) calculation
Osteoporosis Dual-energy x-ray absorptiometry At most, every 2 yr
Thyroid dysfunction Thyroid-stimulating hormone
(hypothyroidism or
hyperthyroidism)level
Tobacco use Inquiry about tobacco use At least once
Visual deficits Snellen visual acuity Yearly
Cancer Screening Recommendations for Elderly Patients
Cancer to Be Detected Test Frequency Breast cancer Mammography Every 2 yr
Cervical or uterine cancer Papanicolaou (Pap) test At least every 3 yr
Colon cancer Screening test (FOBT/FIT, FOBT: Yearly
flexible sigmoidoscopy, FIT and DNA: Every 3 years
colonoscopy)
FOBT
FIT
DNA
Flexible sigmoidoscopy Every 5 yr
Sometimes used with FOBT FOBT- Faecal occult blood test , FIT - Faecal immunochemical test