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PREVENTION FOR OLDER ADULTS
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Even in older adults, preventive interventions can limit disease and disability. The heterogeneity of medical conditions, life expectancy, and goals of treatment, however, requires a thoughtful and individualized application of prevention guidelines. This approach tailors preventive interventions to an individual, balancing benefits and harms in the context of a patient’s life expectancy and values rather than using a one-size-fits-all approach based solely on age.
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There are many guidelines that include recommendations about preventive interventions in older adults. Since the 1980s, the US Preventive Services Task Force (USPSTF) has provided evidence-based scientific reviews of preventive interventions to guide primary care decision making. The fundamental standard applied by the task force is whether the intervention leads to improved health outcomes (eg, reduced disease-specific morbidity and mortality). Services graded A and B are recommended, whereas those with a C grade require consideration of “individual circumstances.” In 1998, the Assessing Care of Vulnerable Elders (ACOVE) project began developing quality indicators specific for vulnerable older persons (defined as age >65 years and life expectancy <2 years). This project concluded that high-quality evidence about benefits and harms is often limited for interventions in older adults. The American Geriatric Society (AGS) also has published several guidelines on health promotion with a geriatric focus. Table 20–1 provides a summary of conditions for which screening or other preventive interventions have been shown to result in net benefit for some older people based on USPSTF and geriatrics-focused guidelines. The table also provides general guidance for translating national guidelines into individualized decisions with each patient.
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