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Prevention
-any activity that reduces the incidence and severity of disease, disability and premature death
Health Promotion
ways to help older people change negative health habits
Primary Prevention
practicing good health habits and getting vaccinated to prevent an illness
-- taking asprin is an example
Secondary Prevention
engaging in particular health screening to detect disease at an early, treatable state
Tertiary Prevention
properly caring for an already established disease to stay as well as possible
What is the largest government-sponsored and monitored program to establish priorities and set goals to improve the health of US citizens
The Healthy People Initiative
When and why was Healthy People started?
1979
set goals to reduce mortality in infants, children, adolescents, and adults
What did HP2000 focus on?
improving the health of groups such as the poor, minorities, and those without health insurance
What did HP2010 focus on?
set two broad goals:
-to increase the length and quality of life
-to eliminate health disparities among ethnic and racial subgroups
Primary Prevention:
Vaccines and Pills
what vaccines should elders get?
+Influenza- life threatening in elders so they should get their flu shot once a year
+Pneumococcal pneumonia- significant cause of illness and death in elders, they should get the vaccine (mostly only one shot but some may need a booster shot)
+Tetanus- rare in the US but should get it either 3 times in your life or every 10 years depending on exposures
Secondary Prevention:
Screening
-targeted to populations at risk for conditions
-done on healthy people to find disease early when it can be treated
-include health interviews, family history, height, weight, and blood pressure as well as lab tests, x-rays etc.
-tests when there are no symptoms
Screenings
done when there are no symptoms, just preventative
Diagnostic tests
when there are symptoms and you are trying to figure out what is wrong with your patient
Characteristics of ideal screening tests
-detects illness before signs and symptoms are present
-test must be accurate with a minimum of false negatives and positives
-screening and early detection must improve health
-preferably, screening people should result in a longer life, as evidenced by well-conducted research
Screening tests for elders:
Breast Cancer
-randomized controlled studies have shown a reduction in mortality for those over 50
-mammograms should be conducted yearly for women over 50
-breast self-exams should also be conducted
Screening tests for elders:
Colorectal cancer
-screening can find precancerous polyps and cancer at the early stage
-fecal occult blood test or digital rectal exam should be conducted yearly from 40-50
-after 50, barium enema, colonoscopy or sigmoidoscopy every 3-7 years
Screening tests for elders:
Prostate cancer
-can be screened with digital rectal exam or prostate-specific antigen (PSA) blood test
-screen is controversial
-most recommend screening after age 50, but most discuss the pros and cons of screening
Screening tests for elders:
Heart Disease
-could start with lifestyle screenings like cigarette smoking, sedentary lifestyle, hypertension
-medical tests like exercise EKG
-medical tests are nor recommended on a routine basis
Screening tests for elders:
Hypertension
-lowering blood pressure reduces death rates
-screen with blood pressure cuff
-may need to be screened 1-2 years, but with high blood pressure, monitoring is essential
Screening tests for elders:
High Cholesterol
-can safely be treated so screening is recommended
-women over 45 and men over 35 should e screened with blood tests about every 5 years
-lipid levels are less likely to increase after 65
Screening tests for elders:
osteoporosis
-DXA or dual energy x-ray absorptometry is the most accurate test
-routine screenings are recommended for women over 65
-men and black women may not benefit from screenings because they have higher bone desnsity
Screening tests for elders:
Vision
-use of Snellen eye charts for vision loss is widely recommended
-glaucoma can be screened for and early treatment may help
-large scale tests are underway to determine if screening and treatment can prevent blindness from glaucoma
Screening tests for elders:
hearing
-treating hearing-impaired adults can improve quality of life
-counseling and interviews may be the best type of screening
-audiometric testing could be done every ten years or for those with hearing loss
Screening tests for elders:
problem drinking
-risk of alcoholism declines with age
-screening should include specific question regarding the quantity, frequency, and degree of intoxication
-all people who drink should be counseled on the dangers of excessive drinking
Tertiary Prevention details
-occurs after the diagnosis of illness
-attempts to prevent further disability, complications or death including testing, treatments and rehab
-may include education- giving someone more control over the course of the illness
Examples of tertiary education
-teaching diabetics to check their blood sugar and manage their illness
-teaching those with heart failure to weigh themselves and watch their fluid intake
-flexibility exercises for those with arthritis
-proper diet for those with hypertension or heart disease
T/F: Preventative services are underutilized and underfunded
True. People know they are available but don't know where to go to find them
sometimes it's issues of money to pay for them and sometimes it's easier to take a pill than to change behaviors
Do Medicare, private insurance, doctors and patients focus on preventative care?
No, again, it's easier to take a pill
Medicare's history and current stances on preventative care
-originally it specifically excluded preventative care
-now helps cover many screenings and immunizations
the majority of diseases that effect Americans are due to what?
lifestyle
In the last 20 years, how has cardiovascular disease changed in the US and why?
there has been a significant decrease due to nationwide health promotion campaigns about risk factors
(individual, community, legislative, and nationwide basis)
Stages of behavior change
-precontemplation
-contemplation
-preparation
-action
-maintenance
Specific Health Promotion Interventions:
Smoking Cessation
-20% of all deaths are linked to smoking cigarettes
-10% of elders still smoke
-5-10 years after you quit smoking, cancer risk drops
-doctors need to screen for tobacco use and encourage quitting
Specific Health Promotion Interventions:
Physical activity couseling
-all age groups should engage in physical activities that are tailored to each person's capabilities
-physician counseling has not been shown to be effective
---perhaps because exercise is a difficult habit to het into and office counseling is quick and nonspecific
Specific Health Promotion Interventions:
Dietary counseling
-for those with diet-related chronic diseases, intensive behavioral counseling is recommended
-take a dietary history, address potential barriers to change, offer specific guidance and recommend follow up
Specific Health Promotion Interventions:
Motor vehicle injury prevention
-fewer elders drive and they drive less
-elders should be cautioned agains drunk driving, encouraged to wear seatbelts and educated about their medications and driving
Specific Health Promotion Interventions:
Fall prevention
-falls are a leading cause of unintentional injury and death among elders
-providing education about falls is not enough to help elders
-instead, exercise, safety behaviors, environmental hazard reduction, and medication review is recommended
Ultimate goal of prevention=
to live longer better
Self-care=
-any individual effort to maintain or improve wellness
-includes screenings, seat belts, decreasing stress, reviewing medical records, installing grab bars, having a good diet, books on medical conditions etc.
Public Policy change to promote health
-changing laws brings about large scale health changes in some situations--> seatbelt laws, airbags/antilock brakes, clean water, speed limits
-helps if the policy and regulations are being funded by the government enacting the change
