Health Promotion, Disease Prevention, and Care Across the Continuum
Prevention is a life-expectancy calculation
Health promotion questions ask who benefits, when, and for how long. Use USPSTF grades and age cutoffs, but individualize by life expectancy and time-to-benefit. Colorectal cancer screening typically stops around age 75, or earlier with limited life expectancy; mammography is individualized from 40 to 74; lung cancer screening with low-dose CT is for ages 50–80 with at least 20 pack-years and current or quit within 15 years. Vaccines: influenza annually, COVID-19 per current schedule, pneumococcal according to age and risk, shingles from age 50, Tdap every 10 years, and RSV for older adults per current guidance. Verify live-vaccine contraindications in immunocompromise.
Geriatric syndromes and the continuum
Screen for falls, polypharmacy, incontinence, frailty, cognitive impairment, depression, and social determinants. Deprescribe drugs with unfavorable risk-benefit profiles (for example, benzodiazepines, anticholinergics, and sulfonylureas causing hypoglycemia). Transitional care-medication reconciliation, teach-back, follow-up within 7 days for high-risk discharges, and home health-reduces readmissions.
Traps
Screening a nursing-home resident with advanced dementia for cancer; missing that screening intervals differ by modality; forgetting that prevention includes advance care planning; and assuming a Medicare Annual Wellness Visit is a comprehensive physical (it is a prevention visit).
Worked rule: time-to-benefit
If time-to-benefit exceeds estimated life expectancy, the test or treatment is unlikely to help. For a 90-year-old with severe frailty, prioritize symptom control and function; for a healthy 70-year-old, complete indicated screening and vaccines.
Key principle
Prevention is not one-size-fits-all; document the rationale for starting and stopping.