Health Promotion, Wellness, and Prevention Across the Aging Continuum
What the candidate must understand
Prevention has three tiers: primary (prevent disease, e.g., vaccination, physical activity), secondary (early detection, e.g., bone density screening, blood pressure screening), and tertiary (limit disability from existing disease, e.g., cardiac rehab, fall prevention after a fracture). Physical therapists work mostly in tertiary and secondary prevention but should advocate for primary prevention.
Know the physical activity guidelines for older adults: at least 150 minutes of moderate-intensity aerobic activity per week (or 75 vigorous), muscle strengthening on 2 or more days, and balance training for those at fall risk. Know that any activity is better than none, and that the guidelines apply to adults with chronic conditions with appropriate modification.
Health behavior change uses motivational interviewing and the transtheoretical model (precontemplation through maintenance). Screen for social determinants: transportation, food insecurity, housing, social isolation, and health literacy. Loneliness and social isolation are independent risk factors for mortality and functional decline.
Traps
- Confusing the tiers of prevention in vignettes (e.g., calling cardiac rehab primary prevention).
- Assuming older adults cannot or will not exercise; the evidence contradicts this.
- Ignoring health literacy when giving a home program.
- Overlooking that social connection is itself a health intervention target.
Rule of thumb
Match the intervention to the stage of change: in precontemplation, raise awareness rather than prescribe a program; in action, support self-efficacy and relapse prevention. Always ask what the patient values doing, and build the plan around that activity.