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On average, each day longer you live, the longer you are likely to live, yet the closer to dying you become. The goal of health maintenance (HM) is to help people live longer and healthier lives.


In this chapter, the findings and positions of the United States Preventative Service Task Force (USPSTF) are emphasized because it generates the most comprehensive and evidence-based recommendations of any organization. Hence, knowing the USPSTF grading system for its recommendations is important (Table 15-1). The USPSTF is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is the leading independent panel of private-sector experts in prevention and primary care.

Table 15–1.USPSTF grade definitions.

This chapter describes prevention then presents HM by the age groups 18-39, 40-49, 50-59, 60-74, and ≥75 years of age. USPSTF Grade A and B recommendations are emphasized with highlights to some areas of special interest or controversy, including sections on immunizations and aspirin.

Health maintenance involves three types of prevention: primary, secondary, and tertiary (Figure 15-1).

Figure 15–1.

The three types of disease prevention.


A. Primary Prevention

Targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition (eg, childhood vaccination programs, water fluoridation, smoking prevention programs, clean water, and sanitation). The disease does not exist. The goal ...

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