|
|||||||
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Disease prevention is even more important in older people than in younger people. Several important preventive activities can help people stay healthy and independent for as long as possible. With good, preventive health care on a routine basis, we can remain functioning longer and extend our lifespan. In other words, older Americans have considerable control over the quality of their health.Preventive Services Recommended for People Aged 65 and Older
On average, a person who is 65 years old can expect to live another 16 years. A person who is 75 can expect to live another 10 years, and a person who is 85 can expect to live another 6 years. People 75-85 years old can also expect to be able to function independently for at least half of that period. In these age groups, our health care goal shifts from extending lifespan to postponing dependency. While preventing disease is still important, maintaining good health for older adults focuses on preventing a loss of function and supporting the abilities we need to remain independent. In other words, the focus changes to vitality, function, and quality of life (rather than just to preventing disease and surviving).
First-level prevention is designed to stop disease before it starts (ie, to reduce the risk of getting a disease). In can include changes in behavior and habits, and it is also important to keep up to date on vaccinations. Cigarette smoking remains the single most preventable cause of death in the United States for both men and women. Quitting can increase life expectancy, lower the risk of heart disease, and improve lung function and blood circulation. People who have stopped smoking found it helpful to do the following:
Exercise is an important way to prevent many types of health problems, including cardiovascular disease, falls, and depression. The health benefits from regular physical activity are probably greater in older adults than in younger adults. Exercise should be a regular, day-to-day activity. It does not need to be overly strenuous. Walking is recommended for everyone who is physically able. Walking can be done almost anywhere and at no or very low cost. People who walk for about 30 minutes a day can improve their health. Even small amounts of exercise by those who are typically not very active can have health benefits. Eating a well-balanced diet and maintaining a healthy weight is very important as we age. A regular review with your health care provider of the calories, fluid, cholesterol, fiber, sodium, and minerals in your diet is useful. The number of calories you eat should be balanced against the amount of energy you use. Saturated fats should make up less than 10% of total calories. Saturated fat intake can by limited by eating fish, chicken without skin, low-fat dairy products, and lean meats. However, certain fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon are high in fatty acids that contain omega-3, a compound that can help prevent heart attack and stroke. Older adults without heart disease are encouraged to eat a variety of fish (preferably fatty) at least twice a week. Other sources of omega-3 include oils and foods like flaxseed, canola and soybean oils, and walnuts. Whole grains, fruits, and vegetables are also highly recommended. Easy ways to reduce salt intake include cutting down on salt use at the table and limiting the use of prepared (eg, canned or packaged) foods. Women generally need to increase their calcium intake as they age. In addition to these general guidelines, you should consider individual counseling from a nutritionist, dietitian, or physician if you have specific health problems and dietary needs. (See also Nutrition.)Alcohol is a problem for about 5% of people over 65 years of age. Drinking too much increases injuries, gastrointestinal illness, and liver disease. It can also cause potentially reversible mental illness. However, having one drink per day (eg, one beer, one mixed drink, or one glass of wine) can reduce risk of heart attack and stroke. Regardless, people who have memory problems should not drink any alcohol. Cholesterol continues to be a risk factor for heart disease as we age, along with smoking, high blood pressure, and lack of exercise. Eating a balanced, low-fat diet is beneficial for preventing heart disease as well as for preventing cancer and other forms of illness. People at higher risk, such as those who already have some heart disease, may benefit from further steps to lower cholesterol. Car accidents are the leading cause of fatal injuries in adults up to age 75. The crash rate for older drivers (adjusted for the actual miles that they drive) is higher than for any other age group except for drivers under 25. All drivers, of course, should wear seat belts and should not drink before driving. Older drivers may need to change their driving techniques and habits to adjust to certain changes associated with aging (eg, decreased vision). It’s sensible to take a refresher course to improve your knowledge and skills. Both driver education and retraining are offered through the American Association of Retired Persons (AARP) and the American Automobile Association (AAA). People with severe visual or hearing loss, dementia, or certain neurologic diseases should seriously consider not driving. Accidental injury is the sixth leading cause of death among people 65 years old and older. Many of these injuries are related to falls and car accidents. A fall at home that causes serious injury might require hospitalization and possibly care in a nursing home or a rehabilitation facility. Your healthcare provider can offer advice about the following:
Everyday safety behaviors include:
Examples of ways to decrease hazards in the environment include:
In addition to general home safety, additional precautions are necessary in special circumstances. For example, if someone in the household uses oxygen, do the patient and all caregivers know how to use and clean the equipment correctly? Are any other types of medical support equipment in use? If so, is the equipment in working order? Does everyone in the household know how to use it properly and safely? Does everyone know what to do if the equipment stops working? A more formal evaluation of your home to help prevent injuries can also be done by a physical or occupational therapist. Regular dental visits are important as we age. Many common problems can be found during regular dental visits, including infection in the gums, dry mouth, and cancer. Both daily brushing with toothpaste that contains fluoride and flossing are also necessary for good dental health. One regular-strength aspirin tablet every other day is recommended to prevent coronary heart disease, but only if you have two or more of the following risk factors:
Aspirin therapy can also lower your risk of a second heart attack. However, you should not take aspirin if you have uncontrolled high blood pressure, severe liver disease, ulcers, or any other condition that increases the risk of bleeding. Your health care provider can advise if aspirin therapy is recommended for you. Although vaccination is most often thought of as being important for children, it continues to be important as we age. Medicare covers the costs of flu, pneumonia, and tetanus immunizations. Flu shots: During influenza (flu) epidemics, the hospitalization rate for older people increases two to five times. Vaccination for the flu is necessary every year because the flu virus constantly changes. This means that the antibodies in our blood from previous infection or vaccination last year might not protect us this year or next. Everyone 65 years old or older, or those under 65 who have other illnesses, should receive a flu shot every year between September and mid November. Medical personnel and caregivers for high-risk patients should also be vaccinated. Side effects are usually rare, but include fever, chills, aches and pains, and general feelings of ill health. People who are allergic to eggs or any part of the vaccine should not get a flu shot. If you should not get a flu shot, your healthcare provider can tell you about other options to prevent the flu. If you do get the flu, some oral medications are available that can reduce flu symptoms. Pneumonia vaccine: Pneumococcal infections continue to be the leading cause of pneumonia and can contribute to disability and death. Of the more than 40,000 deaths caused by these infections each year, 80% are in people over 65 years old. Everybody 65 or older (and people younger than 65 who have other illnesses) should be vaccinated against pneumococcal diseases, such as pneumonia. Side effects after revaccination are rare and mild. If it has been 5 or more years since you were vaccinated and if you received that vaccination when you were younger than 65, you should be vaccinated again. If you are unsure if you have ever been vaccinated against pneumonia, it is best to be vaccinated again. This vaccine cannot totally prevent pneumonia and related diseases, but it is still recommended for older adults. Diphtheria/Tetanus vaccine: Diphtheria and tetanus are rare but are associated with a high death rate. Over half (60%) of tetanus infections are in people 60 years old and older. So, older adults who have never been vaccinated should receive two tetanus shots, 1-2 months apart, followed by a third shot 6-12 months later. After that, tetanus booster shots should be given about every 10 years. After vaccination, there may be pain or swelling where the shot was given. Rarely, someone may have an allergic reaction. People who have had an allergic or other bad reaction to a previous tetanus shot should not be vaccinated again. Second-level prevention refers to efforts to improve the health of people who already have a disease. It focuses on screening to detect disease early and to begin treatment as soon as possible. In addition to the general preventive activities, second-level prevention includes screening for specific diseases of aging.Almost half of new cases of serious cervical cancer, including deaths from cervical cancer, are in women 65 years old and older. All women who are or have been sexually active and who have not had a hysterectomy should have a Pap smear every 1-3 years. Women over 65 years old who have regularly had normal Pap smears in the past usually no longer need to have Pap smears. For older women who have never had a Pap smear, screening can be stopped after two normal annual Pap smears. Medicare covers Pap smears performed every 3 years. Screening by having an annual examination and a mammogram every 1-2 years is recommended. In general, active older women with a life expectancy of 5 years or longer should have a mammogram at least every 2-3 years. Women at high risk, such as those with a history of breast cancer or abnormal mammograms, should have a mammogram every year. Medicare covers annual screening mammograms. Older adults should be screened for colon cancer by having a diagnostic procedure called a colonoscopy done. In addition, your healthcare provider may recommend testing for blood in the stool that cannot be seen without a microscope (fecal occult blood testing) and possibly a sigmoidoscopy. (A sigmoidoscopy is a procedure that is similar to a colonoscopy, done to examine the colon). Screening for colon cancer is especially important for people who have any of the following risk factors:
Medicare will cover a screening colonoscopy every 10 years, fecal occult blood testing every year, and a sigmoidoscopy every 2 years. Screening for prostate cancer is controversial because the disease usually progresses very slowly. In addition, evidence to support the benefit of treatment for early disease is lacking. Only 1 in 380 men with prostate cancer die of the disease. Your doctor can advise you on whether or not you should be screened for prostate cancer. The CAGE questionnaire is often used to indicate signs of alcohol dependence or abuse in older people. Answering "yes" to any of the questions below suggests a drinking problem.C Have you ever felt you should Cut down?A Does others’ criticism of your drinking Annoy you?G Have you ever felt Guilty about drinking?E Have you ever had an "Eye opener" to steady your nerves or get rid of a hangover?Routine screening for diabetes mellitus is recommended if you have risk factors such as obesity, a family history of diabetes, or diabetes mellitus that developed during pregnancy. Symptoms that indicate the need for testing include the following:
Sugar levels are routinely measured as part of many blood and urine tests. (See also Diabetes.)An electrocardiogram (ECG) is not an effective screening test for heart disease. However, cardiac stress testing may be useful before beginning an exercise program. If you have had a heart attack, controlling risk factors such as cigarette smoking, high cholesterol, and high blood pressure is very important to prevent another. In addition, drug treatment in the first 3 years after a heart attack seems to reduce risk of death. (See also Disorders of the Heart and Circulatory System.)Depression is common in older adults, but treatment can be highly effective. To help determine if you are depressed, your health care provider might use the Geriatric Depression Scale. You will be asked to respond to a number of questions by answering "yes" or "no" based on how you felt over the past week. (See also Depression.)A calculation of body mass index (BMI), can be used to estimate your ideal weight. Your BMI is calculated by dividing your weight in kilograms by the square of your height in meters (ie, kg/m2). Definitions for obesity in men and women follow: Men: BMI greater than or equal to 27.8 kg/m2 Women: BMI greater than or equal to 27.3 kg/m2 On the other hand, sudden weight loss can also be a problem. An unintentional weight loss of 10 pounds in 6 months can indicate malnutrition or a serious illness and should be discussed with your healthcare provider. (See also Nutrition.)The chances of developing high blood pressure increase with age. Treating high blood pressure in older adults can reduce the chance of stroke and heart attack. A normal systolic blood pressure (the first or top number) should be 140 or less. The diastolic blood pressure (the bottom or second number) should be 90 or less. High systolic blood pressure is more common than high diastolic blood pressure after age 65. It is often associated with a drop in blood pressure when the person stands up. To determine if this is the case for you:
In general, your standing blood pressure is the one to use in deciding if your blood pressure is normal. Because blood pressure varies more as we grow older, it needs to be measured more often. In addition, older adults are more likely to have side effects from treatment, so they should be watched carefully if treatment for high blood pressure is started. If you are taking blood pressure medication and feel dizzy or lightheaded, you should contact your healthcare provider. (See also High Blood Pressure.)Most women 65 years old and older should be screened for osteoporosis (thin or brittle bones) by having a bone density test. People who are at high risk of broken bones should have a bone density test at age 60. Your healthcare provider can explain the importance of getting enough calcium in your diet, stopping smoking, exercising, and avoiding falls. (See also Osteoporosis.)Common eye diseases in older adults include glaucoma, cataracts, and macular degeneration. In glaucoma, the pressure within the eyeball increases, leading to gradual loss of vision. Cataracts develop when the lens of the eye becomes cloudy and blocks light from passing into the eye. In macular degeneration, vision loss begins in the center of the visual field and progresses slowly, ultimately leading to blindness. These three diseases and outdated prescription glasses account for most visual problems among older adults. (See also Vision Problems.)Hearing loss can lead to a feeling of being isolated from others. You should tell your healthcare provider if you’re having any problems with hearing and ask whether a hearing aid would be helpful. (See also Hearing Difficulty.)Cholesterol and Triglycerides Correcting cholesterol and triglyceride levels lowers the risk of future problems in older adults who have evidence of blockage in their arteries (eg, a history of heart attack or chest pains). Keeping your levels of cholesterol and triglycerides within the normal range is important to reduce your risk of cardiovascular problems including heart attack and stroke. Guidelines are as follows:
Treating healthy older adults who have mildly increased levels is not currently recommended. Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) both become more common as we age. Your healthcare provider might perform a blood test to screen for these conditions, especially in older women. If any of the moles on your skin change in appearance, or if the appearance of your skin changes in general, you should be checked by your healthcare provider. People who are light-skinned or who have had skin cancer in the past have a high risk of developing skin cancer. They should limit the amount of time they spend outside in the sun and should wear protective clothing when outdoors. Do not hesitate to tell your healthcare provider if you notice a new skin spot or one that has changed shape, color, or size. Dementia should be detected as soon as possible because a combination of medications, education, and counseling can benefit both patients and their families. It is important to control risk factors such as high blood pressure and high levels of cholesterol and triglycerides. This may be helpful for patients with dementia caused by cardiovascular problems or Alzheimer’s disease. Staying mentally active by reading, learning new things, or working crossword puzzles may also help prevent dementia. It’s not a bad idea to play Jeopardy! (See also Problems with Remembering, Thinking, and Understanding.)Third-level prevention refers to efforts to prevent disability from becoming worse. This is done by regular and thorough monitoring and treatment of disease, including rehabilitation. Third-level prevention is needed most for older adults who often do not seek care for common sources of disability. Your healthcare provider may recommend a comprehensive geriatric assessment.Comprehensive Geriatric Assessment The comprehensive geriatric assessment is one way to identify current medical problems, sources of disability, and needed future care. Usually, a team of healthcare providers is involved so that all areas of a person’s life are considered. Having a thorough assessment is especially important when our health status changes quickly, or when a change in living arrangements appears necessary. Using checklists of ways to support health in older adults helps us stick with any recommendations. |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Published: 3/15/2005