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Today’s older adults are increasingly interested in promoting healthy aging. The terms health promotion and prevention are used almost interchangeably. Prevention runs a gamut. For the most part, we think of prevention in terms of warding off disease or delaying its onset, but prevention can also involve simply avoiding bad events or complications of care. As noted in Chapter 4, in the context of chronic disease management, proactive primary care represents a form of prevention (tertiary prevention, as defined later). Prevention is typically targeted at specific diseases or conditions, but among older adults prevention of syndromes such as falls, dizziness, and functional decline are more important. Moreover, some preventive efforts, like stopping smoking and exercising, can affect many diseases.

Ageism may lead people to discount the value of prevention in caring for older persons, but the evidence suggests that many preventive strategies are effective in this age group. Ironically, the effects of prevention may be the greatest in older people because the benefit of preventive activities depends on two basic factors: the prevalence of the problem and the likelihood of an effective intervention. Thus, flu and pneumonia shots, for example, have the advantage of preventing not only the risk of disease but also may result in a shorter period of illness and less of a need for hospitalization and risk of functional decline. Likewise, osteoporosis prevention is more cost-effective in older adults than in younger individuals because the baseline levels of the problem, and of falling, are high. Plans for prevention in older people should consider the issues delineated in Table 5-1. Perhaps the most preventable problem connected with caring for older persons is iatrogenic disease.

TABLE 5-1.Considerations in Assessing Prevention in Older Patients

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