Screening and preventive services for older adults

Abstract

Federal, professional, and academic efforts are converging to address the preventive care needs of older Americans. Medicare is placing an increased emphasis on preventive care services for older adults. With the passage of the Patient Protection and Affordable Care Act, access to preventive services has been enhanced by reducing out-of-pocket costs for older adults and increasing reimbursement to healthcare providers. In 2010-11, newly revised guidelines for screening and preventive services have been issued by the US Preventive Services Task Force and the Centers for Disease Control and Prevention. In addition to these guidelines and the landmark changes in Medicare coverage, there are significant new attempts to modify national screening recommendations based on age and expected risk/benefit for older adults. These population-specific guidelines with new emphasis on functional status and multiple risk factor reduction are of increasing importance to an aging population, where more conventional disease-focused guidelines are less suitable for maintaining physical function and quality of life. Evidence-based measures of physical performance appropriate for primary-care office use are being developed and piloted. As a result of these policies, guidelines, and tools, we have the ability to offer older adults more comprehensive, cost-effective screening and preventive measures than in any other previous time. Mt Sinai J Med 78:498-508, 2011. © 2011 Mount Sinai School of Medicine.

Figure 1. Days of Life Lost by Stopping Screening at Various Ages (39)

Figure 2. Example of the Ideal Analytic Framework for Geriatric Topics (10)

*Risk factors include increasing age, baseline functional impairment and limitations, incontinence, polypharmacy, medical risk, or sensory and cognitive deficits.

Figure 3. Relative Emphasis of Screening and Preventive Services According to Functional State of Older Adults