Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T09:05:44.691Z Has data issue: false hasContentIssue false

Chapter 4 - Screening and Prevention

from Section I - General Approach to the Care of the Elderly

Published online by Cambridge University Press:  30 June 2022

Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Preventive health is a broad term encompassing screening tests (e.g., for cancer, cardiovascular risk, or geriatric syndromes), healthy lifestyle counseling (e.g., nutrition and physical activity), immunizations, and safety considerations (e.g., falls, driving). These discussions become more important with age as a clinician considers an individual patient's goals and values, prognosis and life expectancy, and whether a patient is likely to benefit. The 4Ms (what Matters, Medications, Mentation, and Mobility) provide a useful framework for thinking about how to frame discussions with older adults in the primary care setting, and the Medicare Annual Wellness Visit provides an opportunity to review screening and prevention with an older adult and to update goals and preferences. The overarching goal should be to follow evidence-based practice, cause no harm to our patients, and align with what matters most to the patient.

Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 33 - 43
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mate, KS, et al. Creating Age-Friendly Health Systems: A vision for better care of older adults. Healthcare. 2018; 6(1):46.Google Scholar
Tipirneni, R, Ganguli, I, Ayanian, JZ, Langa, KM. Reducing disparities in healthy aging through an enhanced Medicare Annual Wellness Visit. Public Policy Aging Rep. 2019; 29(1):2632.CrossRefGoogle ScholarPubMed
Lee, KT, Harris, RP, Schoenborn, NL. Individualized approach to cancer screening in older adults. Clin Geriatr Med. 2018; 34(1):1123.Google Scholar
Schoenborn, NL, Huang, J, Sheehan, OC, Wolff, JL, Roth, DL, Boyd, CM. Influence of age, health, and function on cancer screening in older adults with limited life expectancy. J Gen Intern Med. 2019; 34(1):110117.Google Scholar
Kotwal, AA, Walter, LC, Lee, SJ, Dale, W. Are we choosing wisely? Older adults’ cancer screening intentions and recalled discussions with physicians about stopping. J Gen Intern Med. 2019; 34(8):15381545.Google Scholar
Breslau, ES, Gorin, SS, Edwards, HM, Schonberg, MA, Saiontz, N, Walter, LC. An individualized approach to cancer screening decisions in older adults: A multilevel framework. J Gen Intern Med. 2016; 31(5):539547.Google Scholar
Siu, AL, US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement [published correction appears in Ann Intern Med. 2016 (Mar. 15); 164(6):448]. Ann Intern Med. 2016; 164(4):279296.Google Scholar
Committee on Practice Bulletins – Gynecology. Practice Bulletin Number 179: Breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017; 130(1):e1e16.CrossRefGoogle Scholar
Oeffinger, KC, Fontham, ET, Etzioni, R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [published correction appears in JAMA. 2016 (Apr. 5); 315(13):1406]. JAMA. 2015; 314(15):15991614.Google Scholar
US Preventive Services Task Force, Curry, SJ, Krist, AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018; 320(7):674686.Google Scholar
Committee on Practice Bulletins – Gynecology. ACOG Practice Bulletin Number 131: Screening for cervical cancer. Obstet Gynecol. 2012; 120(5):12221238.CrossRefGoogle Scholar
Sawaya, GF, Kulasingam, S, Denberg, TD, Qaseem, A, Clinical Guidelines Committee of American College of Physicians. Cervical cancer screening in average-risk women: Best 13. Practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2015; 162(12):851859.CrossRefGoogle Scholar
US Preventive Services Task Force, Bibbins-Domingo, K, Grossman, DC, et al. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement [published correction appears in JAMA. 2016 (Aug. 2); 316(5):545] [published correction appears in JAMA. 2017 (Jun. 6); 317(21):2239]. JAMA. 2016; 315(23):2564–2575.Google Scholar
Wolf, AMD, Fontham, ETH, Church, TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018; 68(4):250281.CrossRefGoogle ScholarPubMed
Qaseem, A, Crandall, CJ, Mustafa, RA, Hicks, LA, Wilt, TJ, Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer in asymptomatic average-risk adults: A guidance statement from the American College of Physicians. Ann Intern Med. 2019; 171(9):643654.Google Scholar
Moyer, VA, US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2014; 160(5):330338.Google ScholarPubMed
Wender, R, Fontham, ET, Barrera, E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013; 63(2):107117.Google Scholar
US Preventive Services Task Force, Grossman, DC, Curry, SJ, et al. Screening for prostate cancer: US Preventive Services Task Force Recommendation Statement [published correction appears in JAMA. 2018 (Jun. 19); 319(23):2443]. JAMA. 2018; 319(18):19011913.Google Scholar
Wolf, AM, Wender, RC, Etzioni, RB, et al. American Cancer Society guideline for the early detection of prostate cancer: Update 2010. CA Cancer J Clin. 2010; 60(2):7098.Google Scholar
Qaseem, A, Barry, MJ, Denberg, TD, Owens, DK, Shekelle, P, Clinical Guidelines Committee of the American College of Physicians. Screening for prostate cancer: A guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013; 158(10):761769.CrossRefGoogle ScholarPubMed
Rosendorff, C, Lackland, DT, Allison, M, et al. (American Heart Association, American College of Cardiology, and American Society of Hypertension). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation. 2015; 131:e435e470.CrossRefGoogle Scholar
Siu, AL, US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015; 163(10):778786.Google Scholar
Tinetti, ME, McAvay, GJ, Fried, TR, Allore, HG, Salmon, JC, Foody, JM, Bianco, L, Ginter, S, Fraenkel, L. Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes. J Am Geriatr Soc. 2008; 56(8):14091416.Google Scholar
Siu, AL; US Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015; 163(11):861868.Google Scholar
Pippitt, K, Li, M, Gurgle, HE. Diabetes mellitus: Screening and diagnosis [published correction appears in Am Fam Physician. 2016 (Oct. 1); 94(7):533]. Am Fam Physician. 2016; 93(2):103109.Google Scholar
Kirkman, MS, Briscoe, VJ, Clark, N, et al. Diabetes in older adults. Diabetes Care. 2012; 35(12):26502664.CrossRefGoogle ScholarPubMed
US Preventive Services Task Force, Owens, DK, Davidson, KW, et al. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA. 2019; 322(22):22112218.Google ScholarPubMed
Ali, MU, Fitzpatrick-Lewis, D, Kenny, M, Miller, J, Raina, P, Sherifali, D. A systematic review of short-term vs long-term effectiveness of one-time abdominal aortic aneurysm screening in men with ultrasound. J Vasc Surg. 2018; 68(2):612623.Google Scholar
Kim, LG, Scott, RA, Ashton, HA, Thompson, SG, Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007; 146(10):699.Google Scholar
Brauer, CA, Coca-Perraillon, M, Cutler, DM, Rosen, AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302(14):15731579.Google Scholar
US Preventive Services Task Force, Curry, SJ, Krist, AH, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2018; 319(24):25212531.Google Scholar
Black, DM, Rosen, CJ. Clinical practice: Postmenopausal osteoporosis [published correction appears in N Engl J Med.; 374(18):1797]. N Engl J Med. 2016; 374(3):254262.Google Scholar
US Preventive Services Task Force, Bibbins-Domingo, K, Grossman, DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement [published correction appears in JAMA. 2020 (Feb. 18); 323(7):669] [published correction appears in JAMA. 2020 (Feb. 18); 323(7):669–670]. JAMA. 2016; 316(19):19972007.Google Scholar
Goff, DC Jr, Lloyd-Jones, DM, Bennett, G, et al. (American College of Cardiology/American Heart Association Task Force on Practice Guidelines). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(25 Suppl 2):S4973.Google Scholar
Cholesterol Treatment Trialists’ Collaboration. Efficacy and safety of statin therapy in older people: A meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019; 393(10170):407415.Google Scholar
LeFevre, ML, US Preventive Services Task Force. Screening for thyroid dysfunction: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015; 162(9):641650.CrossRefGoogle ScholarPubMed
Stott, DJ, Rodondi, N, Kearney, PM, et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med. 2017; 376(26):25342544.Google Scholar
Mooijaart, SP, Du Puy, RS, Stott, DJ, et al. Association between levothyroxine treatment and thyroid-related symptoms among adults aged 80 years and older with subclinical hypothyroidism [published online ahead of print, 2019 (Oct. 30)]. JAMA. 2019; 322(20):111.Google Scholar
Chou, R, Dana, T, Bougatsos, C, Blazina, I, Khangura, J, Zakher, B. Screening for hepatitis B virus infection in adolescents and adults: A systematic review to update the US Preventive Services Task Force recommendation. Ann Intern Med. 2014; 161(1):3145.CrossRefGoogle ScholarPubMed
US Preventive Services Task Force, Owens, DK, Davidson, KW, et al. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force Recommendation Statement [published online ahead of print, 2020 (Mar. 2)]. JAMA. 2020; 323(10):970975. doi: 10.1001/jama.2020.1123.Google Scholar
Fuller, GF. Falls in the elderly. Am Fam Physician. 2000; 61(7):21592174.Google Scholar
Tinetti, ME, Inouye, SK, Gill, TM, Doucette, JT. Shared risk factors for falls, incontinence, and functional dependence: Unifying the approach to geriatric syndromes. JAMA. 1995; 273(17):13481353.CrossRefGoogle ScholarPubMed
Mathias, S, Nayak, US, Isaacs, B. Balance in elderly patients: The “get-up and go” test. Arch Phys Med Rehabil. 1986; 67(6):387389.Google Scholar
Phelan, EA, Mahoney, JE, Voit, JC, Stevens, JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015; 99(2):281293.CrossRefGoogle ScholarPubMed
2020 Alzheimer’s disease facts and figures [published online ahead of print, 2020 (Mar. 10)]. Alzheimers Dement. 2020; 16(3):391460. doi: 10.1002/alz.12068.Google Scholar
US Preventive Services Task Force, Owens, DK, Davidson, KW, et al. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2020; 323(8):757763.Google ScholarPubMed
Galvin, JE, Sadowsky, CH, NINCDS-ADRDA. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Fam Med. 2012; 25(3):367382.Google Scholar
Burke, WJ, Wengel, SP. Late-life mood disorders. Clin Geriatr Med. 2003; 19(4):777797.Google Scholar
Siu, AL, US Preventive Services Task Force (USPSTF), Bibbins-Domingo, K, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016; 315(4):380387.Google Scholar
Chou, R, Dana, T, Bougatsos, C, Grusing, S, Blazina, I. Screening for Impaired Visual Acuity in Older Adults: A Systematic Review to Update the 2009 US Preventive Services Task Force Recommendation. Rockville, MD: Agency for Healthcare Research and Quality (US), 2016.Google Scholar
Moyer, VA, US Preventive Services Task Force. Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157(9):655661.Google Scholar
Lin, FR, Yaffe, K, Xia, J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013; 173(4):293299.Google Scholar
Dong, XQ. Elder abuse: Systematic review and implications for practice. J Am Geriatr Soc. 2015; 63(6):12141238.Google Scholar
Lachs, MS, Pillemer, KA. Elder abuse. N Engl J Med. 2015; 373(20):19471956.Google Scholar
Hemmelgarn, B, Suissa, S, Huang, A, Boivin, JF, Pinard, G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA. 1997; 278(1):2731.Google Scholar
Pomidor, A, ed. Clinician’s Guide to Assessing and Counseling Older Drivers. 4th edition. New York: The American Geriatrics Society, 2019.Google Scholar
Messinger-Rapport, BJ. How to assess and counsel the older driver. Cleve Clin J Med. 2002; 69(3):184192.Google Scholar
Grohskopf, LA, Alyanak, E, Broder, KR, Walter, EB, Fry, AM, Jernigan, DB. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2019–20 influenza season. MMWR Recomm Rep. 2019; 68(3):121.Google Scholar
Reed, C, Chaves, SS, Daily Kirley, P, et al. Estimating influenza disease burden from population-based surveillance data in the United States. PLoS One. 2015; 10(3):e0118369.Google Scholar
Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2018–19 influenza season. www-cdc-gov.proxy1.library.jhu.edu/flu/fluvaxview/coverage-1819estimates.htm. Accessed on 6/29/20.Google Scholar
DiazGranados, CA, Dunning, AJ, Kimmel, M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014; 371(7):635645.CrossRefGoogle ScholarPubMed
Burke, M, Rowe, T. Vaccinations in older adults. Clin Geriatr Med. 2018; 34(1):131143.Google Scholar
Matanock, A, Lee, G, Gierke, R, Kobayashi, M, Leidner, A, Pilishvili, T. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: Updated recommendations of the Advisory Committee on Immunization Practices [published correction appears in MMWR Morb Mortal Wkly Rep. 2020 (Jan. 3); 68(5152):1195]. MMWR Morb Mortal Wkly Rep. 2019; 68(46):10691075.Google Scholar
Tomczyk, S, Bennett, NM, Stoecker, C, 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 Morb Mortal Wkly Rep. 2014; 63(37):822825.Google Scholar
Cunningham, AL, Lal, H, Kovac, M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016; 375(11):10191032.CrossRefGoogle ScholarPubMed
Dooling, KL, Guo, A, Patel, M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018; 67(3):103108.Google Scholar
Liang, JL, Tiwari, T, Moro, P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018; 67(2):144.Google Scholar
Nelson, NP, Link-Gelles, R, Hofmeister, MG, et al. Update: Recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for postexposure prophylaxis and for preexposure prophylaxis for international travel [published correction appears in MMWR Morb Mortal Wkly Rep. 2019 (Mar. 8); 68(9):233]. MMWR Morb Mortal Wkly Rep. 2018; 67(43):12161220.CrossRefGoogle Scholar
Schillie, S, Vellozzi, C, Reingold, A, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018; 67(1):131.Google Scholar
Guadagni, V, Drogos, LL, Tyndall, AV, et al. Aerobic exercise improves cognition and cerebrovascular regulation in older adults. Neurology. 2020; 94(21):e2245e2257.CrossRefGoogle ScholarPubMed
Gillespie, LD, Robertson, MC, Gillespie, WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; (9):CD007146.Google Scholar
Kvamme, JM, Holmen, J, Wilsgaard, T, Florholmen, J, Midthjell, K, Jacobsen, BK. Body mass index and mortality in elderly men and women: The Tromso and HUNT studies. J Epidemiol Community Health. 2012; 66(7):611617.Google Scholar
Wilson, MM, Thomas, DR, Rubenstein, LZ, et al. Appetite assessment: Simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005; 82(5):10741081.Google Scholar
Wilson, SR, Knowles, SB, Huang, Q, Fink, A. The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES). J Gen Intern Med. 2014; 29(2):312319.CrossRefGoogle ScholarPubMed
Burns, DM. Cigarette smoking among the elderly: Disease consequences and the benefits of cessation. Am J Health Promot. 2000; 14(6):357361.Google Scholar
LeFevre, ML, US Preventive Services Task Force. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2014; 161(12):902910.Google Scholar
US Preventive Services Task Force, Owens, DK, Davidson, KW, et al. Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019; 321(23):23262336.Google Scholar
Lee, KC, Ngo-Metzger, Q, Wolff, T, Chowdhury, J, LeFevre, ML, Meyers, DS. Sexually transmitted infections: Recommendations from the US Preventive Services Task Force. Am Fam Physician. 2016; 94(11):907915.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×