Health Maintenance

Question 1

Goals of Health Promotion/Prevention in the Elderly

Answer 1

Maximize quality & quantity of life
Contribute to preserving indepence & decreasing discomfort
Focus on elements of lifestyle, environment & health care management that delays onset of chronic disease

Question 2

Define Aging

Answer 2

Characterized by the gradual decline of physical & physiologic capacity

Question 3

Define Promotion

Answer 3

Prevention of avoidable decline, frailty & dependence

Question 4

Goals of Screening

Answer 4

Reduce premature mortality caused by acute & chronic illness
Maintain function
Enhancing QOL
Extending active life expectancy

Question 5

Role of PCP

Answer 5

Promote health at every opportunity

Individualize in terms of age, functional status, patient preference, culture, SES

Question 6

Modifiable Risk Factors for CV Disease & Cerebrovascular Disease

Answer 6

HTN
Smoking
Inactivity
Cholesterol
Obesity
DM

Question 7

Single Most Important Activity in Reducing Morbidity & Mortality in the Elderly

Answer 7

BP

Especially orthostatic BP

Question 8

Screening for Cholesterol

Answer 8

Controversial
Less likely to increase after 65 years of age
Those on meds should be screened yearly

Question 9

Screening for DM

Answer 9

High risk for DM2

Established DM patients need A1C & glucose monitoring

Question 10

Screening for Smoking

Answer 10

Counseling

Education on smoking cessation

Question 11

2nd Leading Cause of Death in the Elderly

Answer 11

Cancer

Question 12

Things to Think About with Cancer Screening in the Elderly

Answer 12

Expected time-to-benefit
Risk of developing the cancer in the patient’s lifetime
Individual’s estimated life expectancy
Focus on colorectal, breast, cervical & lung cancer screening

Question 13

Potential Harms with Screening for Cancer

Answer 13

False positive leading to interventions & anxiety
Over diagnosis
Cost, discomfort, & embarrassment associated available tests

Question 14

Breast Cancer Screening

Answer 14

Yearly PE
SBE
Mammograms suggested every 1-2 years through age 75 & with a life expectancy of at least 10 years
75+ if woman is at high risk

Question 15

Cervical Cancer Screening

Answer 15

May be discontinued for women 65+ with 3 normal Pap smears over preceding 10 years
Discontinue for hysterectomy for benign indication

Question 16

Prostate Cancer Screening

Answer 16

50-69 most likely to benefit
Routine screening not recommended
Discuss risks vs. benefits
Stop after age 69 or life expectancy less than 10 years

Question 17

Colorectal Cancer

Answer 17

50-75 who have 5+ years to live
76-85 depends on prior screening, risk factors, co-morbidities
Not over age 86
Colonoscopy

Question 18

Other Screening Tests for Colorectal Cancer

Answer 18

CT colonography
Flexible sigmoidoscopy
Stool testing for blood or stool
DNA testing

Question 19

Lung Cancer Screening

Answer 19

Education on smoking cessation

55-80: low dose spiral CT to HIGH RISK individuals until 15 years out from discontinuing or limited life expectancy

Question 20

Define High Risk in Lung Cancer

Answer 20

At least 30 pack year history of smoking

Currently smoking or within 15 years of quitting

Question 21

Skin Cancer Screening

Answer 21

Yearly skin exam

Recommend sunscreen

Question 22

Oral Cancer Screening

Answer 22

Assess yearly

Education on risk: ETOH, smoking

Question 23

Important Immunizations in the Elderly

Answer 23

Tetanus every 10 years
Influenza yearly
Pneumococcal
Herpes Zoster: immunocompetent >60 or immunocompromised persons

Question 24

Osteoporosis Screening

Answer 24

DEXA scans
65+
Routine screening at 60 for increased risk of osteoporotic fractures

Question 25

Vision Screening

Answer 25

Periodically Senile chart Amsler grid Optometrist or ophthalmologist

Question 26

Hearing Screening

Answer 26

Periodically Screened with questionnaire Whisper test Audiogram

Question 27

Social Support

Answer 27

Family & friends available for assistance & emotional support Simple questionnaire Emotional & cognitive problems

Question 28

Fall Prevention Screening

Answer 28

Annual visit Get up & go test (mobility) MMSE Medication assessment

Question 29

Function Screening

Answer 29

ADLs | IADLs

Question 30

Cognition Screening

Answer 30

MMSE

Question 31

Depression Screening

Answer 31

Depression scale

Question 32

Medication Screening

Answer 32

Brown bag test | Have patient bring in all their medications

Question 33

Health Promotion that Correlate the Strongest with Healthy & Successful Aging

Answer 33

Physical activity | Nutrition

Question 34

Exercise & the Elderly

Answer 34

Counseled on benefits of aerobic & resistance exercise & life-style modification

Question 35

Long Term Effects of Sedentary Lifestyle

Answer 35

Functional limitations Obesity Diabetes CV disease

Question 36

Benefits of Exercise in the Elderly

Answer 36

Resilient with respect to CV endurance & strength Improves functional limitations, overall sense of well-being & self esteem, longevity, blood lipids, osteoarthritis, & conditioning Decreases progression to disability Reduces BP & CV disease Reduces abdominal fat & insulin resistance Reduces falls Minimizes or reverses physical frailty Prevents hip fractures

Question 37

Dynamic Aerobic Exercise for the Elderly

Answer 37

``` Swimming Brisk walking Running Bicycling Muscle strengthening ```