Preventive Care, Nutrition, and Health Maintenance
What to know
Preventive care in elders is individualized by life expectancy and goals. Screen for hypertension, colorectal cancer (age-limited), breast cancer (individualize), osteoporosis, and depression; vaccinate per schedule. Fall and functional screening are preventive. Nutrition: screen for malnutrition (MNA), unintentional weight loss, and sarcopenia; address dentition, dysphagia, and social isolation. Vitamin D and calcium for bone health; B12 screening. Exercise (resistance and balance) prevents falls and preserves function. Smoking cessation and alcohol moderation remain relevant. Polypharmacy review is itself preventive care.
Traps
Don't over-screen when life expectancy is short-balance benefit and burden. Weight loss in elders is never "normal" and warrants evaluation (malignancy, depression, dysphagia, medication). Don't forget that preventive care includes fall prevention and medication review, not just cancer screening. Be mindful of overnutrition/obesity paradox questions.
Rule of thumb
"Match the screening to the life expectancy": prioritize interventions that benefit within the patient's expected lifespan.
Worked example
A 90-year-old with advanced dementia and limited life expectancy: focus on comfort, function, and fall prevention rather than routine cancer screening.
Worked example 2
An elder with unintentional weight loss: evaluate for depression, dysphagia, malignancy, and medication side effects before attributing to aging.