Health Maintenance and Disease Prevention
Prevention medicine can be categorized as primary, secondary, or tertiary. Primary prevention aims to remove or reduce disease risk factors. Secondary prevention techniques promote early detection of disease or precursor states e.g routine cervical Papanicolaou screening to detect carcinoma or dysplasia of cervix. Tertiary prevention measures are aimed at limiting the impact of established disease.
Health promotion and disease prevention are a major emerging theme in geriatric medicine and health care generally. Although efforts have typically been targeted at younger persons, there is growing evidence that this approach is both appropriate and feasible for those age 65 and over (Office of Technology Assessment, 1985b). The health promotion and disease prevention approach is one of a number of possible strategies to deal with what has increasingly become a hallmark of current times: the prevalence of chronic illness and multiple chronic illnesses or functional impairments among the elderly.
A note of caution is required before the development of health promotion and disease prevention strategies for the elderly population is enthusiastically endorsed. Attempts to improve the quality of old age require an understanding of the risk factors for common disease among the elderly and the efficacy of strategies to decrease the risk of morbidity. Simplistic generalizations from studies of young and middle age adults to the elderly in this realm are frequently invalid. Middle-aged adults and the elderly differ in their patterns of disease and disease presentation.
Furthermore, the elderly represent a select group of survivors, with physiologic alterations that may influence pathophysiologic processes. For instance, the widely cited Alameda County study reported reduced mortality in young and middle-aged adults who never smoked, drank little alcohol, was physically active, and slept seven or eight hours nightly. In contrast, however, in a similar analysis of elderly Massachusetts residents (Branch and Jette, 1984) it was found that five-year mortality rates were not influenced by alcohol intake, physical activity, or sleeping habits, indicating the age modification of risk factors.
Many effective preventive services are underutilized, and few adults receive all of the most strongly recommended services. Several methods including the use of provided or patient reminder systems can increase utilization of preventive services, but such methods have not been widely adopted.