health maintenance (preventive medicine) in the elderly
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History
- screen for depression (USPSTF & American College of Physicians)
- alcohol screen (USPSTF)
- inquire about symptoms of hypothyroidism (USPSTF)
- inquire about hearing loss (USPSTF)
- inquire about lower extremity claudication (USPSTF)
- physical disability screening (USPSTF & ACP)
- inquire about falls (AGS) {yearly}
- dementia screening (only if symptomatic)
Physical examination
- height-weight monitoring
- blood pressure screening
- full skin examination by dermatologist {high-risk patients}
- hearing screening - Whisper test
- vision screening - insufficient evidence (USPSTF)[5]
- Snellen chart
- retinal exam
- intraocular pressure measurement by ophthalmologist
- oral exam in smokers & alcoholics
- thyroid palpation, if history of radiation exposure
- fall evaluation
- comprehensive geriatric assessment
- home safety evaluation
- digital rectal exam NOT recommended for
- screen for colorectal cancer (AHCPR)
- screen for prostate cancer (USPSTF)
- pelvic exam NOT recommended to screen for ovarian cancer
Laboratory
- thyroid-stimulating hormone {TSH} not indicated (low-value test)[3][11]
- diabetes screening
- serum glucose every 3 years if BP > 135/80 mm Hg
- lipid panel every 5 years
- more often in patients with diabetes mellitus, CAD, peripheral arterial disease, prior stroke
- mortality in patients > 65 years of age not associated any lipid measurement[2]
- HDL inversely associated with myocardial infarction (hazard ratio = 0.85) in patients> 65[2]
- screening for colon cancer until life expectancy < 10 years
- yearly fecal occult blood
- fecal immunochemical testing (FIT) every 2 years
- routine urinalysis NOT recommended (low-value test [11]_
- screening for urinary tract infection
- screening for bladder cancer
- routine CBC NOT recommended for anemia screening
- Pap Smear every 3 years vs HPV testing every 5 years
- unnecessary in women who have had hysterectomy, provided no cervical tissue remains[2]
- not indicated in women > 60 years of age who have previously had normal smears
* USPSTF
Diagnostic procedures
- PPD (SNF residents, Alaskan natives, Native Americans)
- routine screening EKG NOT recommended; low value test[11]
- routine endometrial biopsy NOT recommended for uterine cancer screening
- screening for colon cancer until life expectancy < 10 years
- flexible sigmoidoscopy every 5 years
- colonoscopy every 10 years
* USPSTF
Radiology
- bone mineral density {DEXA}
- at least once after age 65 years (women)
- at least once after age 70 years (men)
- mammogram every 2 years until life expectancy < 10 years
- routine transvaginal ultrasound NOT recommended for ovarian cancer screening
- abdominal ultrasound for abdominal aortic aneurysm: age 65 years (men who have ever smoked)
* USPSTF, except DEXA: AGS, WHO
Management
- Vaccinations:
- influenza vaccine annually (also for health care workers)
- tetanus booster every 10 years, TDaP once
- pneumococcus vaccine
- CDC's Advisory Committee on Immunization Practices recommends Prevnar 15 & Pneumovax 23 or Prevnar 20 for adults aged 65 & older[6][7]
- see pneumococcus vaccine for schedule
- hepatitis A vaccine (Native Americans & Alaskan natives)
- hepatitis B vaccine (dialysis patients)
- Herpes zoster vaccine
- Medications:
- influenza prophylaxis if an outbreak in SNF
- primary prevention of cardiovascular disease
- FDA recommends against aspirin for primary prevention
- statins as per cardiovascular risk calculator
- cardiovascular risk calculator overestimates risk
- statins never compared directly with Mediterranean diet
- calcium & vit D for women > 50 years (AGS)
- medication review, polypharmacy common[4]
- also see health risk factor
- Counseling:
- smoking cessation
- use of seat belts (USPSTF)
- avoid alcohol/drugs before driving/boating/swimming (USPSTF)
- dental hygiene (USPSTF)
- diet & exercise (USPSTF)
- avoid sun overexposure {high-risk patients} (USPSTF)
- reduce water heater setting to 120 degrees F (USPSTF)
- install smoke detectors & change batteries yearly (USPSTF)
- advanced directives counseling
- Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit[8]
More general terms
More specific terms
Additional terms
- exercise for seniors
- health maintenance in nursing home patients
- health risk factor(s)
- primary prevention of cardiovascular disease
References
- ↑ A Karlamangla, UCLA Multicampus Program in Gerontology & Geriatrics, lecture series, March 21, 2002
- ↑ 2.0 2.1 2.2 2.3 Journal Watch 24(23):176-77, 2004 Psaty BM, Anderson M, Kronmal RA, Tracy RP, Orchard T, Fried LP, Lumley T, Robbins J, Burke G, Newman AB, Furberg CD. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study. J Am Geriatr Soc. 2004 Oct;52(10):1639-47. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15450039
- ↑ 3.0 3.1 Journal Watch 25(2):18, 2005 Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frolich M, Westendorp RG. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004 Dec 1;292(21):2591-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15572717
- ↑ 4.0 4.1 Hajjar ER, Hanlon JT, Sloane RJ, Lindblad CI, Pieper CF, Ruby CM, Branch LC, Schmader KE. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc. 2005 Sep;53(9):1518-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16137281
- ↑ 5.0 5.1 U.S. Preventive Services Task Force. Screening for impaired visual acuity in older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009 Jul 7; 151:37. http://www.ahrq.gov/clinic/uspstf09/visualscr/viseldrs.htm PMID: https://www.ncbi.nlm.nih.gov/pubmed/19581645
Chou R et al Screening older adults for impaired visual acuity: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009 Jul 7; 151:44. http://www.ahrq.gov/clinic/uspstf09/visualscr/viseldart.htm PMID: https://www.ncbi.nlm.nih.gov/pubmed/19581646
US Preventive Services Task Force (USPSTF) Screening for Impaired Visual Acuity in Older Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(9):908-914 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26934260 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2497913 - ↑ 6.0 6.1 Sofair A and Chavey E ACIP Recommends 13-Valent Pneumococcal Vaccine for Elders Physician's First Watch, Aug 15, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 7.0 7.1 Tomczyk S et al Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >= 65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 19, 2014 / 63(37);822-825 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25233284 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm
- ↑ 8.0 8.1 Centers for Disease Control & Prevention (CDC) Preventing Chronic Disease. Routine Check-Ups and Other Factors Affecting Discussions With a Health Care Provider About Subjective Memory Complaints, Behavioral Risk Factor Surveillance System, 21 States, 2011. CME ACTIVITY - Volume 13 - January 28, 2016 http://www.cdc.gov/pcd/issues/2016/15_0471.htm
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018
- ↑ Journal Watch 24(15):117-118, 2004 Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. JAMA. 2004 Jun 23;291(24):2990-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15213211
- ↑ 11.0 11.1 11.2 Ganguli I et al. Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit. JAMA Netw Open 2020 Dec 1; 3:e2029891. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33306120 PMCID: PMC7733154 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774080