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
16
Q
Screening for prostate cancer?
A
- men 50-69yo are most likely to benefit
- routine screening not recommended
- discuss risks and benefits of screening w/ pt
- if opting to screen, stop after age 69 or when life expectancy is less than 10 yrs
17
Q
CRC screening?
A
- USPSTF suggests offering CRC screening to individuals 50-75 who have at least 5 yrs to live
- controversial to screen 76-85: depends on prior screening, RFs, co-morbidities
- shouldn’t screen over 86yo
- invasive TOC is colonoscopy q 10 yrs
- other screening tests:
CT colonography, flex sigmoidoscopy, stool testing for blood or stool DNA testing
18
Q
Lung cancer screening?
A
- health education on smoking cessation
- annual low dose spiral CT of chest for high risk individuals ages 55-80 until 15 yrs out from d/c smoking or limited life expectancy
- high risk= at least 30 pack yr hx of smoking and are currently smoking or w/in 15 yrs of quitting
19
Q
Screening for skin cancer?
A
- routine skin exam w/ yearly visit
- recommendations of sunscreen
20
Q
Screening for oral cancer?
A
- assess w/ yearly visit
- teach about risk:
ETOH
smoking
21
Q
What immunizations are recommended in elderly pop?
A
- tetanus (over 60 - account for 60% of cases), get Td q 10 yrs - get TdaP
- influenza: 90% of flu related deaths occur in pts 60 yrs and older, annual, high dose inactivated vaccine approved for 65 and older
- pneumococcal: 13-valent, 23-valent, both should be admin to pts 65 and older
- herpes zoster: recommended for all immunocompetent persons 60 and older, immunocompromised persons may receive an inactivated adjuvanted vaccine
22
Q
Osteoporosis screening?
A
- no mandate on when to stop DEXA scans
- USPSTF recommends that women aged 65 and older be screened routinely for osteoporosis using bone densitometry
- routine screening begins at age 60 for women at increased risk for osteoporotic fractures
- screen men as well if RFs: 1st degree relative, on estrogen therapy, steroids, frailty
23
Q
Screening for hearing and vision?
A
- vision: periodically snellen chart amsler grid optometrist or ophthalmologist - glaucoma - hearing: periodically screened w/ questionnaire, whisper test, audiogram
24
Q
Fall prevention components and fxn?
A
- annual visit
- fall risk assessment - get up and go tes, MMSE, med assessmnet
- fxn: ADLs and IADLs
- mobility: get up and go
25
What are the 2 health promotion activities that correlate the strongest w/ healthy and successful aging?
- physical activity (older adults should be counseled on benefits of aerobic and resistance exercise and life-style modification)
- nutrition
26
Long term effects of sedentary lifestyle?
- fxnl limitations
- obesity
- diabetes
- CVD
27
Postive effects of exercising in this pop?
- fairly resilient w/ respect to cardiovascular endurance and strength even after period of detraining
- improves fxnl limitations
- decreases progression to disability
- reduces BP and CV disease
- reduces abdominal fat and insulin resistance
- reduces falls
- minimizes or reverses physical frailty
- improves overall sense of well-being and self esteem
- prevents hip fractures
- improves longevity
- improves blood lipids
- improves osteoarthritis
- regular exercise improves conditioning, esp those w/ medical conditions such as heart failure, CAD, osteoarthritis, diabetes and recurring falls
28
What are good examples of dynamic aerobic exercise?
- swimming
- brisk walking
- running
- biking
- muscle strengthening
29
goal for elderly pt w/ exercise?
- feel pleasantly tired a few hours after activity
- Rx of exercise should be customized to individual's need, goals, and health status
- start low and go slow
