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Clinical Preventive Services

Elder Care

Presenter:

Nancy Jane C. Friedley, M.D., Director of Clinical Geriatrics, University of Maryland School of Medicine, Baltimore, MD.


One group that is commonly overlooked in the area of preventive care is the elderly population. Many believe that preventive care for older adults is unnecessary. However, older patients are the fastest growing sector of the U.S. population and represent 71 percent of the healthcare dollar. Therefore, it is in the country's best interest to improve healthcare services for seniors.

The goals of preventive care are different for older adults, especially those in their ninth or tenth decade of life. In younger patients, prevention of premature death drives the public health agenda, while prevention of disability and maintenance of function becomes paramount for older adults. Because the goals of prevention in the elderly change, a new paradigm that includes prevention of disability will need an expanded focus for recommendations and resources allocation. Given the new paradigm, prevention resources must target education, screening, immunization, social supports, and research.

For seniors, the three major barriers to receiving appropriate preventive care are:

  • Access.
  • Cost.
  • Ageism.

Few seniors have adequate means of accessing appropriate facilities or trained providers, because of transportation difficulties and a lack of integrated services. If adequate care can be accessed, the costs of preventive care, in terms of copayments, deductibles, and medication prices, are often prohibitive. In addition, many seniors do not feel the need for preventive services, and many healthcare providers do not think it is worthwhile to spend time and money on the elderly.

According to Dr. Friedley, educating and counseling seniors is one of the most efficacious and cost-effective preventive efforts. Successful education programs should address the following topics:

  • Smoking cessation, to prevent vascular disease, chronic lung disease, lung cancer, and osteoporosis.
  • Nutrition, to promote maintenance of optimal weight, good dental health, and appropriate use of supplements.
  • Exercise and mobility, to prevent heart attacks and strokes, diabetes, falls, and hip fractures.
  • Safety programs, to prevent motor vehicle accidents, falls, and burn injuries.

Policymakers at every level can assist seniors in overcoming the barriers to preventive services by employing both public and private resources. The concepts used to develop preventive interventions are applicable to seniors, although the ultimate goals and strategies may differ.

To develop appropriate strategies for seniors, preventive research must:

  • Include elderly subjects.
  • Demand data before extrapolating from younger cohorts.
  • Study the role and efficacy of social supports.
  • Encourage focus on prevention of disability and rehabilitation.
  • Explore the preferences and desires of seniors.

References

Hermanson B, et al. Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease. N Engl J Med 1993;319:1365.

Katzel LI, et al. Effects of weight loss vs. aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. JAMA 1995;274:1915.

Prevention of stroke by antihypertension drug treatment in older persons with isolated systolic hypertension: final result of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265:3255.

Prince RL. Diet and the prevention of osteoporotic fractures. N Engl J Med 1997;337:701.

Rowe JW, et al. Successful aging. Gerontologist 1997;37:433.

Rowe JW. The new gerontology. Science 1997;278:367.

Wetle T. Living longer, aging better. JAMA 1997;278:1376.


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