Primary and secondary prevention Primary prevention is aimed at stopping the disease before its onset, often by reducing or eliminating risk factors. Primary prevention can include immune prophylaxis (vaccination), chemoprophylaxis (chemoprevention and vaccination in the elderly) and lifestyle changes (lifestyle measures that help prevent common chronic diseases). In the context of secondary prevention of a disease is detected and treated early, before symptoms or functional failures occur; characterized morbidity and mortality are minimized. Screening can be a primary or secondary preventive measure. Screening can be used to identify risk factors that can be changed to prevent disease, or to discover disease in asymptomatic people who can then be treated early. Chemoprevention and vaccination in the elderly disease to be prevented Task Frequency Notes *, Atherosclerotic cardiovascular disease (coronary heart disease, stroke) chemoprevention with aspirin daily for men aged 45-79 years, when the risk of heart attack is greater than the risk of gastrointestinal bleeding, and for women aged 55-79 years, when the risk of ischemic stroke is greater than the risk of gastrointestinal bleeding: USPSTF recommendation for patient s> 80 years: USPSTF recommendation I Optimal dose unknown (75 mg p.o. but may be as effective as higher doses and less risk of gastrointestinal bleeding once a day have) influenza vaccination every year for everyone: a recommendation from the CDC coverage through Medicare: One-time vaccination during an influenza season pneumococcal infection vaccine once at the age of 65 years for those ? 65 years: CDC recommendation (which also recommends a single booster shot for ? 65-year-old when ? vaccinated 5 years ago and at the time of primary vaccination <65 years old were) coverage by Medicare: One-off Vaccination (the acquisition of a revaccination depends on the state of the patient) tetanus shot every 10 years for all ? 65 years: CDC recommendation to maintain a booster schedule, the people should have been never vaccinated, to administer the primary immunization zoster vaccination once at the age of 60 years for all ? 60 years: the CDC recommendation for a one-time vaccination, regardless of a history of varicella zoster or * USPSTF recommendations based on evidence level and net benefits (benefits minus damage): A = Strong evidence for Partnership B = contrast, good evidence for Partnership C = distance between benefits and harms is too low to justify a recommendation D = evidence I = Insufficient evidence for or against a recommendation coverage through Medicare, if available. Depending on the investigation incurred for patient co-payments and deductibles. For people at high risk for influenza A (z. B. during outbreaks in nursing homes) can be started at the time of vaccination and be continued for 2 weeks oseltamivir or zanamivir. CDC Centers for Disease Control and Prevention; USPSTF = US Preventive Services Task Force. Lifestyle measures that help prevent common chronic diseases measures disease Examples quitting arteriosclerotic cardiovascular disease (coronary heart disease, stroke), cancer, COPD, diabetes mellitus type 2, hypertension, osteoporosis achieve and maintain a desirable body weight arteriosclerotic cardiovascular disease (coronary heart disease, stroke), type 2 diabetes mellitus, hypertension, osteoarthritis reducing saturated fat e and avoid trans fats in the diet arteriosclerotic cardiovascular disease (coronary heart disease, stroke), cancer, diabetes mellitusTyp 2, hypertension Increased intake of fruit, vegetables and fiber arteriosclerotic cardiovascular disease (coronary heart disease, stroke), (possibly) cancer hypertension Increased aerobic exercise arteriosclerotic cardiovascular disease (coronary heart disease, stroke), cancer reduction of sodium in the diet Arteriosclerotic e cardiovascular disease (coronary heart disease, stroke), hypertension Reduced consumption of cured or smoked foods cancer Minimum radiation and sun exposure cancer muscle strengthening and elongation osteoarthritis Moderate physical activity osteoarthritis Adequate calcium and vitamin D intake and sun exposure Osteoporosis Regular exercise with weights osteoporosis Restricted caffeine consumption osteoporosis Restricted alcohol consumption (1 drink / day) * Osteoporosis * 1 drink = one 12 oz can of beer (about 360 ml), a 5 oz glass of wine (150 ml), 1.5 oz distilled alcohol (ca. 50 ml). Screening recommendations for elderly patients disease to be recognized examination frequency Notes *, abdominal aortic aneurysm abdominal ultrasonography once at the age of 65-75 years for men who have ever smoked: USPSTF recommendation B For men who have never smoked: Recommendation C for women:. recommendation D abuse or neglect after maltreatment ask (for example, "Are there problems with the Famili Over which would like to inform me e or household members? ") At least once USPSTF recommendation I alcohol abuse alcoholism-screening questionnaire (eg. B. AUDIT, AUDIT-C) each year for all adults, including the ? 65 years. USPSTF recommendation B in patients ? 65 years and test result is positive USPSTF recommendation B for short behavioral counseling and measures for patients in alcoholism fulfill criteria: recommendation for abstinence symptoms (eg, dementia, delirium.) screening tool (eg Mini-Cog.) for cognitive impairment NA USPSTF recommendation I depression (major depression) depression screening questionnaire (for . B. PHQ-2) Annually For all adults, including the ? 65 years. Mellitus USPSTF recommendation B Type 2 diabetes plasma glucose levels every year for all patients with a blood pressure ? 130/85 mmHg: USPSTF recommendation B for the general population ? 65 years: Recommendation I for Adults with cholesterol levels at the border to a treatment: screening for diabetes as part of the assessment of cardiovascular risk coverage through Medicare: screening every 6 months for people with hypertension, dyslipidemia, or a history of high plasma glucose levels dyslipidemia fasting serum total, LDL and HDL cholesterol levels ; optional triglycerides least every 5 years More common in people with coronary heart disease, diabetes or peripheral arterial disease or a stroke for women ? 45 years of risk factors for coronary heart disease and for all men ? 35 years of age: USPSTF recommendation coverage through Medicare: Screening all 5 years risk of falls question after falls in the past year and by difficulty in walking and in holding the balance, floor-walking test annually recommendation by AGS and BGS for independent living patients ? 65 years with increased risk of falls: USPSTF recommendation B for exercise and vitamin D supplementation Glaucoma measurement of intraocular pressure Annual USPSTF Recommendation I coverage by Medicare: Annual screening for high-risk patients (each patient with diabetes or a family history of glaucoma, African American ? 50 and Latin American ? 65 years) hearing deficits hearing test at the bedside annually for all ? 65s : USPSTF recommendation I HIV HIV testing of serum, blood or oral fluid at least once for all 15- bi s 65-year-olds and for patients> 65 years with HIV risk factors: USPSTF Recommendation A hypertension blood pressure measurement at least every 2 years in people with a blood pressure <120/80 mmHg common in people with higher blood pressure values ??for all ? 18-year-olds: USPSTF- recommendation obesity or malnutrition determination of body height and weight calculation of BMI (kg / m2) § At least annually for alleErwachsenen: USPSTF recommendation B osteoporosis calculated Doppelröntgenabsorptiometrie more than every 2 years for all women ? 65 years and for women <65 years with ? 9.3% hydrogen risk of osteoporotic fracture over 10 years, using the FRAX (Fracture Risk Assessment) -Instruments: USPSTF recommendation B coverage Medicare: screening every 2 years after age 50, or more frequently if medically necessary thyroid dysfunction (hypothyroidism or hyperthyroidism) levels of thyroid stimulating hormone NA USPSTF recommendation I tobacco question of tobacco use At least once USPSTF recommendation for all patients who report a tobacco: smoking cessation counseling and appropriate medical therapy Visual deficits Snellen acuity test annually to all ? 65 years: The USPSTF recommendation I * USPSTF recommendations based (on evidence level and net benefits benefits minus damage): a = Strong evidence for Partnership B = Good, however evidence for Partnership C = distance between benefits and harms is too low to justify a recommendation = D = Insufficient evidence I Evidence for or against a recommendation coverage through Medicare, if available. Depending on the investigation incurred for patient co-payments and deductibles. USPSTF recommends screening only in practices with systems that ensure accurate diagnosis, effective treatment and follow-up. § BMI ? 25 = overweight; BMI ? 30 = obesity. AAOS = American Academy of Orthopedic Surgeons; AGS = American Geriatrics Society; AUDIT = Alcohol Use Disorders Identification Test; AUDIT-C = short form AUDIT Consumption Test; BGS = British Geriatrics Society; BMI = body mass index; NA = Not applicable; PHQ-2 = Patient Health Questionnaire-2; USPSTF = US Preventive Services Task Force. Recommendations for tumor screening in elderly patients tumor to be recognized examination frequency Notes *, breast cancer mammography every 2 years for women aged 50 to 74 years: USPSTF recommendation B for women ? 75 years: USPSTF recommendation I; Proposal by AGS to continue the screening, unless the life expectancy is <10 years coverage by Medicare: Annual screening cervical or uterine carcinoma Papanicolaou (Pap) test (the evidence for newer methods is not enough) At least every 3 years for women > 65: USPSTF recommendation D against a screening when the results of the last adequate screening were normal and the women do not have a high risk for women with total hysterectomy for benign disease: USPSTF recommendation D against conducting a Pap test stimulation of to end AGS and ACS, the screening in women> 70 years, if the last two results were normal (women have never attended a screening> 70 years, should the screening erfo lgen; if two test results at intervals of one year are normal, the screening may be terminated) coverage by Medicare: Annual screening in women at high risk; otherwise every 2 years colon cancer screening test (FOBT, sigmoidoscopy, colonoscopy) – For all 50- to 75-year-olds: USPSTF recommendation A for 76- to 85-year-old patient, USPSTF Recommendation C against routine screening (citing a very low net benefits) for patients ? 85 years of age: USPSTF recommendation D against a screening FOBT annually coverage through Medicare: Annual FOBT Flexible sigmoidoscopy every 5 years Sometimes together with FOBT used coverage through Medicare: Flexible sigmoidoscopy every 4 years or 10 years after a colonoscopy colonoscopy every 10 years coverage by Medicare: colonoscopy every 2 years in high-risk patients or otherwise every 10 years (but not within 4 years after sigmoidoscopy) prostate cancer PSA measurement DRE PSA measurement usually every 1-4 years USPSTF recommendation D against a screening cover by Medicare: Yearly PSA measurement and DRE * USPSTF recommendations based on evidence level and net benefits (benefits minus damage): A = Strong evidence for Partnership B = contrast, good evidence for Partnership C = distance between benefits and harms is too low to justify a recommendation D = evidence I = Insufficient evidence for or against a recommendation coverage through Medicare, if available. Depending on the investigation incurred for patient co-payments and deductibles. ACS = American Cancer Society; AGS = American Geriatrics Society; DRE = digital rectal examination; FOBT = occult blood test; PSA = prostate-specific antigen; USPSTF = US Preventive Services Task Force. Tertiary prevention As part of the Tertiary prevention adequate management an existing symptomatic, usually chronic disease in order to prevent further loss of function. The disease management is supported by the use of disease-specific guidelines and protocols. Several disease management programs have been developed: Disease Specific Care Management: A specially trained nurse who works with a general practitioner or geriatrician, coordinated oriented protocols care, arranges support services and trains the patient. Clinics for long-term care: patients with the same chronic illness will be trained in groups and attended by a health professional; this approach can help patients with diabetes in achieving better blood sugar control. Specialists: patients with a chronic disease that is difficult to stabilize, can be referred to a specialist. This approach works best when specialist and general practitioner working together. Patients with the following chronic diseases that are common in the elderly, may be able to benefit from a tertiary prevention. Arthritis Arthritis (v a osteoarthritis;.. Significantly less rheumatoid arthritis) affects about half of ? 65s. It leads to movement restrictions and increases the risk of osteoporosis, aerobic and muscular deconditioning, falls and Druckgeschwüre.Osteoporose bone density measurements can detect osteoporosis before it leads to a break. Calcium and vitamin D supplementation, sports and, if necessary, stopping smoking can the progression of osteoporosis prevent and treatment can new fractures vermeiden.Diabetes hyperglycemia, in particular a concentration of glycosylated hemoglobin (Hb A1c)> 7 9% of at least 7 years, increases the risk of retinopathy, neuropathy, nephropathy, and coronary heart disease. The glycemic treatment targets should be adjusted based on patient preferences, comorbidities and life expectancy. For instance, to adequate HbA1c targets could be: <7.5% of otherwise healthy elderly diabetic patients with a life expectancy of> 10 years <8.0% for patients with comorbidities and a life expectancy of <10 years <9.0% for the frail patients with a limited life expectancy control of hypertension and dyslipidemia is particularly important in diabetic patients. Patient education and examinations of the feet at every visit to foot ulcers verhindern.Gefäßerkrankungen Elderly patients with a history of coronary heart disease, cerebrovascular disease or peripheral vascular disease are at high risk for events that lead to disability. The risk can mitigated through aggressive management of vascular risk factors (eg. As hypertension, smoking, diabetes, obesity, atrial fibrillation, dyslipidemia) werden.Herzinsuffizienz morbidity from heart failure is significant among the elderly, and the mortality rate is higher than in many cancers. A corresponding aggressive treatment, in particular the systolic dysfunction, reduce the functional decline, hospitalization and the Mortalitätsrate.Chronisch obstructive pulmonary disease (COPD) smoking cessation, appropriate use of inhalers and other drugs and patient education concerning energy saving behavioral techniques reduce the number and severity of exacerbation of COPD, which leads to hospitalization.