Health Maintenance Flashcards
1
Q
Normal aging?
A
- gradual decline of physical and psychologic capacity
- potential loss of independence by this change is a major concern - often fear of this is greater than fear of death
2
Q
Does health promotion equate w/ disease prevention?
A
- no, promotion is prevention of avoidable decline, frailty and dependence
3
Q
Goals of health maintenance?
A
- major targets of prevention should be focused at major causes of death
w/ goals being:
-reducing premature mortality caused by acute and chronic illness
-maintaining fxn
-enhancing quality of life
-extending active life expectancy
4
Q
What is the PCP’s role iin health maintenance?
A
- promote health at q opportunity
- effectiveness needs to be individualized in terms of:
pt’s age
fxnl status
pt preference
culture (minority women tend to have higher rates of disability, esp in terms of fxnl independence, culture is impt in understanding older adults health belief system)
socioeconomic status: tend to use preventative services less
5
Q
When is it recommended that screening be stopped?
A
- stopped at 85 for healthy older adults, esp those who have had repeated negative screening in the past, who are frail, or demented, or who have a limited quantity and quality of life remaining
6
Q
Modifiable risk factors for CVD and and cerebrovascular disease?
A
- HTN
- smoking
- inactivity
- cholesterol
- obesity
- DM
7
Q
What is the single most impt activity in reducing morbidity and mortality in the elderly?
A
- checking BP: both systolic and diastolic
- should be done at least yearly
- 140/90 needs to be eval
- although the opinion about the use and dosage of aspirin is not uniform, a daily low dose is usually recommended
8
Q
Screening - serum cholesterol?
A
- controversial, USPSTF concluded that benefits of screening for and tx lipid disorders in middle aged and older people substantially outweigh harms
- age to stop screening wasn’t established
- repeated screening is less impt in older people b/c lipid levels are less likely to increase after 65yo
- those already on lipid lowering meds should be screened at yearly
9
Q
Screening for diabetes?
A
- unclear whether asx older pts will see reduction in micro and macrovascular disease or mortality benefit from tx of diabetes w/ glucose lowering therapy
- clinicians may choose to screen selected persons at high risk for type 2 DM
- for est diabetic pts: A1C and glucose monitoring should be ongoing
10
Q
What can make the difference in smoking cessation?
A
- repeated urging of need to quit coupled w/ self-help materials and nicotine or bupropion Rx can make a difference
11
Q
2nd leading COD in elderly? Screening for this?
A
- cancer
- incidence increases w/ age
- decision to offer cancer screening to the older pt presents a clinical challenge - assess the benefits and risks of screening for older adults on an individual basis
12
Q
What should provider think about b/f screening for cancer?
A
- expected time to benefit
- risk of developing the cancer in pt’s lifetime
- individual’s estimated life expectancy
- focus on colorectal, breast, cervical, and lung cancer screening
- consideration must be given to value placed by pt on prolonging life and his or her willingness to undergo invasive procedures and accept side effects of tx
13
Q
What are the potential harms assoc w/ screening for cancer?
A
- false + results leading to unnecessary interventions and anxiety
- over dx (risk of finding then tx a cancer that otherqise wouldn’t have affected the pt’s life
- cost, discomfort, and embarrassment assoc w/ available tests
14
Q
Screening for breast cancer?
A
- yearly physical
- mammograms are suggested q 1-2 yrs through 75 w/ life expectancy of at least 10 yrs
- beyond this age, may be appropriate for a woman in good health, particularly if she is at higher risk b/c of family hx
- SBE recommended
15
Q
Screening for cervical cancer?
A
- most recommendations now indicate that screening maay be d/c for women who have had at least 3 normal pap smears over preceding 10 yrs (or 2 consecutive HPV/pap tests) and are older than 65
- screening may also be stopped among those who have had a hysterectomy for a benign indication
