CUIDADO PREVENTIVO

Geriatric Screening and Preventive Care
Mary C. Spalding, MD, and Sean C. Sebesta, MD Texas Tech University Health Sciences Center at El Paso, El Paso, Texas
Preventive health care decisions and recommendations become more complex as the population ages. The leading causes of death (i.e., heart disease, malignant neoplasms, cerebrovascular disease, and chronic lower respiratory disease) among older adults mirror the actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) among persons of all ages. Many aspects of mortality in older adults are modifiable through behavior change. Patients 65 years and older should be counseled on smoking cessation, diets rich in healthy fats, aerobic exercise, and strength training. Other types of preventive care include aspirin therapy; lipid management; and administration of tetanus and diphtheria, pneumococcal, and influenza vaccines.
Although cancer is the second leading cause of death in patients 65 years and older, a survival benefit from cancer screening is not seen unless the patient’s life expectancy exceeds five years. Therefore, it isbest to review life expectancy, functionality, and comorbidities with older patients when making cancer screening recommendations. Other recommended screenings include abdominal aortic aneurysm for men 65 to 75 years of age, breast cancer for women 40 years and older with a life expectancy greater than five years, and colorectal cancer for men
and women 50 years and older with a life expectancy greater than five years. (Am Fam Physician. 2008;78(2):206-215. Copyright © 2008
American Academy of Family Physicians.)


pproximately 8 percent of the world’s population was 60 years and older in 1950. B y 2000,
this number had increased to 10 percent; it is expected to reach 21 percent by 2050.1 D elivering comprehensive clinical preventive services to this population is important; however, persons older than 65 are rarely included in preventive care research. T his article reviews the leading and actual causes of death and discusses how behaviors, functional status, comorbidities,
and life expectancy can predict who will benefit most from geriatric screening and preventive care.
Leading vs. Actual Causes of Death
The leading causes of death among persons 65 years and older in the United States in 2002 are listed in Table 1.2 T he actual causes of death among persons of all ages are determined by analyzing modifiable risk factors with U.S. mortality data (Table 23).
The actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) mirror the
leading causes of death (i.e., heart disease, malignant neoplasm, cerebrovascular disease,
and chronic lower respiratory disease) in older adults. T herefore, many aspects of
mortality among older adults may be preventable through a change in lifestyle behaviors.
Behavioral Counseling and Other Preventive Therapies Tobaco c essat ion co unseling
Smoking cessation at 65 years of age leads to an increase in life expectancy of 1.4 to 2.0
years for men and 2.7 to 3.7 years for women.4
Additionally, smoking cessation at any age benefits those exposed to secondhand smoke,
which causes 80 to 90 percent of the negative cardiovascular health effects related to personal
smoking.5 T he U.S. P reventive Services Task Force (USPSTF) and the U.S. Surgeon
General recommend three-minute counseling sessions with patients, with or without
the use of pharmacologic aids6,7 (i.e., varenicline [Chantix],8 bupropion [Wellbutrin], or
nicotine products). T elephone support can be a successful adjunct to counseling

Nutrition co unseling
Elimination of industrially produced transfatty acids would avert 6 to 19 percent of all coronary heart disease (CHD) events in the United States each year.9 A diet rich in healthy fats (e.g., the Mediterranean diet;online Table A) is associated with decreased overall mortality.10 Healthy A geing: a Longitudinal study in E urope (HALE ) followed E uropeans 70 to 90 years of age for
10 years and found that use of the Mediterranean diet, moderate to high levels of physical
activity, moderate alcohol consumption,and nonsmoking were associated with a 50 percent reduction in all-cause mortality. 10 N o more than two alcoholic drinks per day for men and one per day for women are recommended.11 T he A merican A cademy of Family P hysicians (AA FP) and the USPSTF recommend nutrition counseling for patients with diet-related illness such
as diabetes or hypertension and those with other risk factors for CHD.12,13 Exercise co unseling
Physical activity is beneficial to all adults. I t reduces the rate of all-cause mortality and
helps to prevent osteoporosis and obesity.14 A regular exercise program is an integral part of any weight-reduction or weightmaintenance program. A lthough the USPSTF recognizes the importance of exercise and the potential benefits of counseling, it is unable to recommend physician counseling because of insufficient evidence of effectiveness.15 T he U.S. Surgeon G eneral recommends that all adults perform aerobic exercise three times per week for a minimum of one half hour, as well as strength training at least twice per week.