Prevención Medica Geriatrica Realidad o Ficción

Educat ional Notes
Preventive Geriatric Medicine: Reality or fiction?
Aya Biderman MD1 and David Galinsky MD2
1Department of Family Medicine, Clalit Health Services and 2Department of Geriatrics, Soroka University Medical Center and
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
Key words: prevention, geriatrics, elderly, quality of life, functionaldependence
IMAJ 2001;3:615±617
See page 618
The primary aim of care for the elderly is
``to help old people remain as indepen-
dent as possible for as long as possible,
and to offer them as much control over
their lives as possible'' [1]. To achieve
this goal, preventive activities must
relate to the pathological processes and
the normal frailties of old age, as well as
to the social andphysical environment
that enhances their effect.
Classical approaches to prevention
must be modified for patients between
the ages of 70 and 80. Opportunities for
primary prevention are scarce, and the
distinctions between secondary preven-
tion (early diagnosis to stop the progress
of disease) and tertiary prevention (ade-
quate treatment of established disease to
diminish disability) areobscure. Delay
of death, limitation of disability, and
maintenance of well being are among the
desired results of early intervention. The
WHO Scientific Group [1], in a search
for a universal endpoint for epidemiolo-
gical studies, proposed the maintenance
of autonomy as the basic requirement of
the elderly. It follows that preventing the
loss of autonomy should be a major
objective ofintervention programs for
this age group. More specific objectives
have been described in the literature,
ranging from the prevention of influenza
to delay in admission to nursing homes.
The vast majority of these objectives,
however, can only be achieved by
implementing multiple intervention stra-
tegies. Many of these require social
support, a change in public attitudes,
and manipulationof the environment, in
addition to activities that target the
individuals directly. This is the holistic
approach to prevention that is embodied
in the new ``health promotion'' ideology.
For most elderly individuals, the objec-
tive is not prevention of a specific disease
(it is often too late for that), but rather
prevention of the progression of disease
to disability, handicap, ordeath. Quality
of life in the later years is becoming ever
more important for individuals, their
families, and society. Thus the question
that must be addressed is: what strategy
should be employed to maintain auton-
omy as long as possible in the presence
of disease? [2].
This paper examines selected issues
for which various preventive strategies
have been advocated, and distinguishes
thenotion of high risk groups among the
elderly in the community. These preven-
tive strategies can be categorized into
five general groups:
. Problems that can be addressed using
traditional prevention approaches.
These are definable diseases or con-
ditions that can be managed success-
fully to prevent further damage, such
as hypertension and glaucoma.
. Behavioral patterns that couldlead to
beneficial or adverse effects on health
status. These health behaviors are risk
factors rather than diseases or im-
pairments. Evidence as to their im-
portance, or the reversibility of their
effects in the elderly, is sometimes
sketchy or contradictory. These be-
havioral patterns include smoking,
diet modification, exercise, weight
control, participation in social activ-
ity, andstress reduction.
. Problems necessitating attention from
professional health care providers.
Physicians see most elderly persons
regularly and have the opportunities
to identify conditions that could
cause disability. More active assess-
ment and intervention on the part of
physicians could potentially prevent
dysfunction (a form of secondary
prevention). Such conditions include...