Health Maintanence

Question 1

Screening in the elderly needs to be individualized based on the patients remaining life expectancy:
-at what age do we generally stop screening?

Answer 1

Generally screening can be stopped at 85YO.

Question 2

What are the modifiable risk factors of Cardiovascular dz and cerebrovascular dz?

Answer 2

HTN

SMoking

Inactivity

cholesterol

obesity

DM

Question 3

WHat is the single most important activity in reducing morbidity and mortality in the elderly?

Serum cholesterol screening:
-how often do we check this? why?

DM screening

Smoking counseling

Answer 3

checking BP is the single most important activity in reducing morbidity and mortality.

Cholesterol:

• screening is controversial, repeated screening is less improtant in older people b/c lipid levels are less likely to increase after 65YO.
• if they dont have a lipid disorder by the time they are 65 they probably wont get one.

For established DM patients A1C and glucose monitoring should be ongoing.

Quit smoking.

Question 4

Do we screen for CA?

Answer 4

we screen for CA if they are expected to live for greater than 10 years.. we also need to ask ourselves if this pt will survive long enough to derive benefit from screening.

May get false positives leading to unnecessary interventions and anxiety.

Question 5

How often do we screen for…

• breast CA
• cervical CA
• prostate CA
• colorectal CA
• lung CA
• skin CA
• oral CA

Answer 5

Breast:
-mammogram every 1-2yrs though age 75 andd with a life expectancy of 10years

Cervical:
-d/c after 3 normal pap smears or 2 normal paps/HPV testing and are older than 65YO.

Prostate CA:

• routine screening not recommended
• stop after age 69YO of when life expectancy is less than 10 years.

Colorectal:

• ages 50-75 who have at least 5 years to live
• should not screen over 86YO

Lung:

• annual low dose spiral CT of chest for HIGH RISK individuals 55-80 until 15yrs out from d/c smoking or limited life expectancy
• *High risk = 30 pack year hx and are currently smoking or within 15 years of quitting smoking

Skin:
-routine skin exam

Oral:
-education about ETOH and smoking risks

Question 6

Immunizations recommended for the elderly

Answer 6

Tetanus: every 10 years

Influenza: annually (inactivated if over 65YO)

Pneumococcal: 13-valent & 23-valent for those 65YO and up.

Herpes zoster: immunocompromised patients greater than 60YO

Question 7

Osteoporosis in the elderly:
-screening
-

Answer 7

Screening; DEXA scans

• women 65YO and older screened routinely.
• those with osteoporotic fx begin screening at 60YO.

Question 8

What are some screening tests for the following:

• vision
• hearing
• fall risk
• function
• cognition
• depression
• medication

Answer 8

Vision

• snellen chart
• amsler grid
• glaucoma

Hearing:

• whisper test
• audiogram

Fall risk:

• Get up and Go
• MMSE
• Medication assessment

Function:
-ADL and IADL

Cognition:
- MMSE

Depression:
-depression scale

Medication:
-brown bag test

Question 9

What two health promotion activities correlate the strongest with healthy and successful aging?

Answer 9

physical activity and nutrition :)