Tools of Prevention

People working to reach their prevention goals have three major tools from which to choose. One tool is establishing a healthy lifestyle, which includes wearing a seat belt, eating a healthy diet, getting some physical exercise, wearing sunscreen, and not smoking. Another tool is getting vaccinated to prevent infectious diseases such as influenza and pneumococcal pneumonia. A third tool is participating in screening efforts so that diseases such as high blood pressure and cancer are detected early.

Healthy Lifestyle

Lifestyle and disease are clearly linked. The three leading causes of death in the United States—heart disease, cancer, and stroke—are more likely to occur in people who make poor lifestyle choices, especially eating a diet high in saturated fats, trans fatty acids, and cholesterol (such a diet increases the risk of having high cholesterol levels in the blood); not exercising regularly; and smoking. By having informative discussions with doctors and other health care practitioners, older people can make good decisions and establish healthy habits.

Some people believe that adopting a healthier lifestyle would take all the fun out of life. Others fear the cost of putting a healthier lifestyle into practice. Establishing a healthy lifestyle, however, need not lead to drudgery and unmanageable costs. Taking responsibility for one's own health can prove to be exciting, rewarding, and affordable.

Healthy eating habits can help older people prevent or control diseases such as high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. A diet that includes plenty of vegetables, fruits, and whole-grain cereals and breads is recommended, in part because such a diet is high in fiber. Cutting down on harmful types of fat (saturated fats and trans fatty acids) by eating fish, skinless poultry, and very lean meat and by choosing low-fat dairy foods is recommended as well. Limiting salt and increasing the intake of calcium are considered to be part of a healthy diet. Limiting calories to maintain an ideal body weight is also recommended.

Physical activity and exercise can play an important role in preventing obesity, high blood pressure, heart disease, stroke, diabetes, some types of cancer, and other health problems, including such vexing problems as constipation. The best routine includes moderate physical activity for 30 minutes or more on all or most days of the week. People who can devote only 10 minutes at a time to physical activity may still reap benefits if they repeat the activity several times throughout the day. Walking is one simple, effective exercise that many older people enjoy. Certain types of exercise can also target specific problems. For example, stretching improves flexibility. Weight lifting helps protect against muscle weakness and osteoporosis by strengthening muscles and increasing bone density. Dancing and tai chi may preserve or even enhance balance, which in turn helps prevent falls.

Quitting smoking is important to a healthy lifestyle. Older people who quit smoking experience many benefits, so it is never too late to quit. A doctor can offer encouragement and advice on ways to avoid situations and circumstances that contribute to a person's tendency to smoke. Further, a doctor can provide information and recommendations on the use of nicotine replacement products, bupropion (a drug that helps reduce cravings), and other tools.

Safe sex practices remain important during later adulthood. Older people who have more than one sex partner can greatly reduce their risk of contracting a sexually transmitted disease by using a latex condom every time they have sex.

Limiting alcohol use is important to a healthy lifestyle as well. Small amounts of alcohol may have some health benefits. However, aging changes the way the body handles and reacts to alcohol. Older people who drink alcohol need to be aware that more than one drink a day may increase their risk of injuries and other health problems.

Injury prevention plays a major role in maintaining a healthy lifestyle. Older people can lower their risk of injury by taking the following precautions:

• Wearing a seat belt regularly, whether as a driver or as a passenger.
• Not driving when taking drugs that cause sedation or at night if night vision is poor.
• Installing smoke and carbon monoxide detectors. Testing and maintaining smoke and carbon monoxide detectors regularly is also important, as is installing fire extinguishers.
• Setting the maximum temperature on a home hot water heater to 130° F or below.
• Cleaning up cluttered areas in the home, removing loose rugs and long phone and electrical cords, maintaining adequate lighting, and adding handrails and traction surfaces (such as strips or mats) to stairways and bathtubs.

Understanding drug therapy is also important. A primary care doctor and pharmacist can provide information on all prescription and nonprescription drugs. Knowing the brand and generic name of all drugs they take; each drug's purpose; the length of time each drug is to be taken; and what activities, foods, drinks, and other drugs are to be avoided while taking each drug can help older people avoid problems. All drugs need to be reviewed with the doctor periodically.

Vaccines

Vaccinations are not just for children; they provide an important defense against certain infectious diseases that affect older people as well.

Influenza (often called flu) is a common viral infection that is potentially dangerous; it can lead to pneumonia and, in many cases, death. Receiving the influenza vaccine is an effective and safe way for people 65 and over to prevent influenza. People who are severely allergic to eggs or egg products, however, cannot receive the influenza vaccine. An influenza vaccine is needed every autumn because of frequent changes in the influenza virus and because protection does not last longer than 1 year.

Pneumococcal pneumonia (a bacterial lung infection) is the most common pneumonia among older people living in their own homes. The pneumococcal pneumonia vaccine is safe, and it may prevent many of the most common types of pneumococcal pneumonia. If pneumococcal pneumonia does occur in someone who has been vaccinated, the infection tends to be less severe. The vaccine also helps prevent pneumococcal infections in other parts of the body, such as the blood. The vaccine is recommended at least one time for everyone 65 and over. Some older people need to be revaccinated a few years later. People who are unsure of whether they ever received the pneumococcal vaccine should be vaccinated.

The tetanus vaccine is safe and effective for preventing tetanus. Tetanus vaccine is often combined with diphtheria vaccine. An older person who has never been vaccinated for tetanus should receive two injections of a combined tetanus and diphtheria vaccine given 1 month apart. For a person who has had an initial series of tetanus and diphtheria vaccine injections, many authorities recommend a tetanus booster or a tetanus and diphtheria booster every 10 years. Others suggest that a single revaccination at age 65 is sufficient.

Screening

Experts agree on the importance of screening for certain health problems that commonly affect older people. These health problems, when detected early, can be cured or, if not curable, treated to help prevent symptoms and complications from developing.

Screening for high blood pressure (hypertension), followed by treatment when needed, helps lower the risk of heart attack, stroke, and kidney failure. Older people should have their blood pressure checked at least once a year. A top reading (systolic blood pressure) less than 140 and a bottom reading (diastolic blood pressure) less than 90 are desirable.

Screening for abnormal cholesterol levels (especially high LDL, the "bad" cholesterol, and low HDL, the "good" cholesterol) and high triglyceride levels is important in young and old people. Screening, followed by treatment when needed, helps to decrease the risk of heart attack, stroke, and peripheral vascular disease. Levels that are often recommended as desirable are LDL less than 130 mg/dL (less than 100 mg/dL for people with certain diseases, such as diabetes or atherosclerosis), HDL greater than 40 mg/dL, and triglycerides less than 150 mg/dL.

Screening for low bone density (specifically osteopenia or osteoporosis, depending on how low the density has become) is recommended for all women 65 and over. Some experts advise repeating the test every 2 to 3 years. Dual-energy x-ray absorptiometry (DEXA) is the most commonly used method for screening, although other tests are available. When low bone density is identified through screening, the risk of fractures can be reduced if osteopenia or osteoporosis is treated.

Vision or hearing loss can interfere with a person's ability to perform everyday activities, which can affect quality of life. Annual vision and hearing tests are recommended.

Screening for depression is recommended for adults of all ages. Screening usually involves responding to a set of certain questions. Experts have not agreed on the frequency with which screening should be repeated. Screening followed by treatment can improve quality of life and decrease the risk of suicide.

Breast cancer found at an early stage is more likely to be curable. A screening mammogram every year or every other year is recommended for women over 50.

Because colorectal cancer is more likely to be curable at an early stage, screening is advised beginning at age 50. However, experts disagree on the best way in which to screen for colorectal cancer and on how often screening should be done. Almost all experts recommend checking a person's stool for small amounts of blood every year. Additionally, most experts recommend that the person undergo a sigmoidoscopy (an examination of the last part of the large intestine with the use of a short flexible viewing tube) every 5 years or a colonoscopy (an examination of the entire large intestine with the use of a longer flexible viewing tube) every 10 years.

Screening for cervical cancer involves the Papanicolaou (Pap) test. Women who have never had a Pap test before reaching age 65 are advised to have two Pap tests 1 year apart. Some experts believe that if both tests are interpreted as normal, further testing is unnecessary. Doctors often recommend discontinuing Pap testing in women who have had normal Pap test results during the 10 years before turning 65.

See the table Potentially Useful Tests for Disease Prevention.