geriatrics
Prevention of Disease in Older Adults
Tertiary Prevention
In tertiary prevention, an existing symptomatic, usually chronic disease is appropriately managed to prevent further functional loss. Disease management is enhanced by using disease-specific practice guidelines and protocols. Several disease management programs have been developed: Disease-specific care management: A specially trained nurse, working with a primary care physician or geriatrician, coordinates protocol-driven care, arranges support services, and teaches patients. Chronic care clinics: Patients with the same chronic disease are taught in groups and are visited by a health care professional; this approach can help patients with diabetes achieve better glucose control. Specialists: Patients with a chronic disease that is difficult to stabilize can be referred to a specialist. This approach works best when the specialist and primary care physician work collaboratively. Patients with the following chronic disorders, which are common among older adults, can potentially benefit from tertiary prevention. Arthritis (primarily Osteoarthritis (OA) ; much less commonly, Dual-energy x-ray absorptiometry (DXA) can detect Diabetes Mellitus (DM) , especially when the glycosylated hemoglobin (HbA1C) concentration is < 7.5% for otherwise healthy diabetic older patients with a life expectancy of > 10 years < 8.0% for patients with comorbidities and a life expectancy of < 10 years < 9.0% for frail patients with a limited life expectancy Control of hypertension and dyslipidemia in diabetic patients is particularly important. Patient education and foot examinations at each visit can help prevent foot ulcers. Older patients with a history of Overview of Coronary Artery Disease , Morbidity due to Heart Failure (HF) is significant among older adults, and the mortality rate is higher than that of many cancers. Appropriate, aggressive treatment, especially of systolic dysfunction, reduces functional decline, hospitalization, and mortality rate. Smoking cessation, appropriate use of inhalers and other medications, and patient education regarding energy-conserving behavioral techniques can decrease the number and severity of exacerbations of Chronic Obstructive Pulmonary Disease (COPD) leading to hospitalization. 