Prevention of Disease
Primary and Secondary Prevention
The objective of primary prevention is to stop disease before it starts, often by reducing or eliminating risk factors. Primary prevention may include immunoprophylaxis (vaccinations), chemoprophylaxis, and behavioral change (eg, via counseling). In secondary prevention, disease is detected and treated at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality.
Screening can be a primary or secondary preventive measure; it can be used to detect risk factors, which may be altered to prevent disease, or to detect disease in asymptomatic people, who can then be treated early.
Tertiary Prevention
In tertiary prevention, an existing symptomatic, usually chronic disease is appropriately managed to prevent further functional loss. Disease management is enhanced by using disease-specific practice guidelines and protocols (eg, those published by the Agency for Healthcare Research and Quality).
Several disease management programs have been developed. In disease-specific case management, a specially trained nurse coordinates protocol-driven care, arranges support services, and teaches patients. In chronic care clinics, patients with the same chronic disease are taught in groups and are visited by a health care practitioner; this approach can help patients with diabetes achieve better glucose control. Patients with a chronic disease that is difficult to stabilize can be referred to a specialist. This approach works best when the specialist and primary care physician work collaboratively.
Patients with the following chronic diseases, which are common among the elderly, can potentially benefit from tertiary prevention:
Arthritis: Arthritis (primarily osteoarthritis; much less commonly, RA) affects about 1/2 of people >= 65. It leads to impaired mobility and increases risk of osteoporosis, aerobic and muscular deconditioning, falls, and pressure ulcers.
Osteoporosis: Tests to measure bone density can detect osteoporosis before it leads to a fracture. Ca supplementation, exercise, and avoidance of cigarette smoking can help prevent osteoporosis, and treatment can prevent new fractures.
Diabetes: Hyperglycemia, especially when the glycosylated hemoglobin (Hb A1c) concentration is > 7.9%, increases the risk of retinopathy, neuropathy, nephropathy, and coronary artery disease. The goal of treatment is an Hb A1c concentration of < 8% for frail diabetic patients and an even lower concentration (< 7%) for patients who are not frail. Patient education and foot examinations at each visit can help prevent foot ulcers.
Vascular disease: Elderly patients with a history of coronary artery disease, cerebrovascular disease, or peripheral vascular disease are at high risk of disabling events. Risk can be reduced by aggressive management of vascular risk factors (eg, hypertension, smoking, diabetes, obesity, atrial fibrillation, dyslipidemia).
Heart failure: Morbidity due to heart failure is significant among the elderly, and the mortality rate is higher than that of many cancers. Appropriate, aggressive treatment, especially of systolic dysfunction, reduces functional decline, hospitalization, and mortality rate.
Chronic obstructive pulmonary disease (COPD): Smoking cessation, appropriate use of inhalers and other drugs, and patient education regarding energy-conserving behavioral techniques can decrease the number and severity of exacerbations of COPD leading to hospitalization.
This topic was last updated July 2005.
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