On the 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 it 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. The rest of this chapter lays out HM by the age groups 18-39, 40-49, 50-59, 60-74, and 75 years or older. USPSTF Grade A & B recommendations are emphasized with highlights 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).
Table 15-1. Wilson-Jungner Criteria for Appraising the Validity of a Screening Program. |Favorite Table|Download (.pdf)
Table 15-1. Wilson-Jungner Criteria for Appraising the Validity of a Screening Program.
|1. The condition being screened for is an important health problem.|
|2. The natural history of the condition is well understood.|
|3. There is be a detectable early stage.|
|4. Treatment at an early stage is of more benefit than at a later stage.|
|5. A suitable test is available for the early stage.|
|6. The test is acceptable.|
|7. Intervals for repeating the test are determined.|
|8. Adequate health service provision is made for the extra clinical workload resulting from screening.|
|9. The risks, both physical and psychological, are less than the benefits.|
|10. The costs are balanced against the benefits.|
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 is to prevent development of disease.
Targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications (eg, routine Papanicolaou smears, and screening for hypertension, diabetes, or hyperlipidemia). The disease does exist, but the person is unaware (asymptomatic). The goal is to identify and treat people with disease.
Targets individuals with a known disease, with the goal of limiting or preventing future complications (eg, rigorous treatment of diabetes mellitus, and post–myocardial infarction treatment with β-blockers and aspirin). The disease exists and there are symptoms. The goal ...