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JAMA Patient Page
December 23 2009

Preventive Care for Older Adults

JAMA. 2009;302(24):2722. doi:10.1001/jama.302.24.2722

It is predicted that by 2030 about 20% of the US population will consist of persons aged 65 and older, and up to 25% in some states. While it is important to provide preventive care (measures taken to prevent diseases or injuries) to persons of all ages, it is also important to tailor that care to the specific age group. The December 23/30, 2009, issue of JAMA includes the first in a series of articles about medical care for older adults.

Factors Involved in Preventive Care

There are several factors involved in determining the type of preventive care a person needs. Of these, life expectancy may be the most important, as some types of preventive care (ie, flu vaccine) are helpful at all ages, whereas others (ie, screening for many types of cancer) have been found to be helpful only if life expectancy is more than 5 years when the screening is done. Determining which preventive care to undergo depends on weighing the likelihood that the person will benefit from the preventive measure (reduce disease or symptoms) against the likelihood that the person will experience harm (for example, treating a condition that otherwise would never have affected the person). Risk of mortality is based on functional status (an individual's ability to perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being) and number and severity of medical conditions. The most common causes of death for each age group are also important in determining which types of preventive care to recommend for a person. No matter what your age, the most important things you can do to prevent disease and be healthy are exercise, eat a healthy diet, and don't smoke.

Preventive Care Activities

Recommendations for preventive care activities may change considerably based on your personal health. There is insufficient evidence to support some screening tests in older adults. However, some vaccines, screening, and actions are recommended for nearly all older adults (see below).

RECOMMENDED PREVENTIVE CARE FOR ADULTS 65 YEARS AND OLDER (BASED ON US PREVENTIVE SERVICES TASK FORCE)

Vaccinations

  • Influenza vaccine (annual)

  • Pneumococcal vaccine (one time)

  • Tetanus vaccine (every 10 years)

  • Zoster (shingles) vaccine (one time)

Screening

  • Alcohol use screening and counseling

  • Breast cancer screening (mammography every 1-2 years)

  • Blood pressure screening

  • Colon cancer screening (up to age 75)

  • Depression screening

  • Diabetes screening (in those with blood pressure over 135/80 mm Hg)

  • Lipid disorder screening (in all men and in women at increased risk of heart disease)

  • Obesity screening (with counseling intervention for those who are obese)

  • Osteoporosis screening (in women at risk)

  • Ultrasound to screen for abdominal aortic aneurysm (one-time screen for men aged 65-75 who have ever smoked)

Preventive Actions

  • Aspirin to prevent cardiovascular disease (to age 79, if benefit outweighs the possible harm)

  • Exercise (3 times per week for 30 minutes and strength training 2 times per week)

  • Healthy diet; dietary counseling for those with high cholesterol and other risk factors for diseases related to diet

  • Limit alcohol consumption (no more than 1 drink per day for women; no more than 2 drinks per day for men)

  • Don't smoke; smoking cessation counseling (for anyone who smokes)

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.

Sources: National Institute on Aging; US Preventive Services Task Force, Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

TOPIC: AGING

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