Preventive Services for Older Adults

An emphasis on a shared decision-making approach is especially important when considering preventive services for older adults. Family physicians and their older patients should consider issues that contribute to the complexity of prevention in older adults, including unique goals of prevention, life expectancy, comorbidities, potential for harm, and patient values and preferences (Harris et al., 2001).

The patient's values and preferences are always important, and shared decision making should occur before the preventive service is provided. Preventive aspirin therapy in elderly persons provides an illustrative example of the need for shared decision making. There are few studies on the use of aspirin for the prevention of cardiovascular disease in older adults. Older adults are at especially high risk of cardiovascular disease but also at high risk of gastrointestinal bleeding from aspirin. Some older men may decide that avoiding a myocardial infarction is of great value, and that having a gastrointestinal bleeding event is not a major problem, and they would probably decide to take aspirin (USPSTF, 2009).

Specific preventive services that are of special interest for older adults include immunizations. The CDC recommends the zoster vaccine for all adults over age 60, pneumococcal vaccine for adults over 65, and influenza vaccine annually for adults over 50 (ACIP, 2009). Other preventive interventions of special importance target common causes of disease and disability and include multifactorial interventions for older adults that improve physical function, maintain independent living, and reduce falls (AGS, 2001; Beswick et al., 2008; Gillespie et al., 2006).

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