Health Promotion and Disease Prevention
Core concepts
Prevention in older adults splits into primary (prevent disease), secondary (early detection), and tertiary (limit disability from existing disease). Know that screening recommendations are individualized by life expectancy and goals: cancer screening may be de-escalated when life expectancy is short or when the burden outweighs benefit. Vaccination is a high-yield area-know that older adults need influenza, pneumococcal, zoster, and COVID-19 vaccines per current schedules, and that vaccine response may be blunted but still beneficial. Emphasize fall prevention, exercise, nutrition, sensory screening, and advance care planning as preventive services. USPSTF-style recommendations for older adults include colorectal cancer screening to age 75 (individualized to 85), osteoporosis screening in women, and blood pressure screening.
Traps
Examiners test whether you apply individualized, goal-concordant screening rather than blanket rules. A distractor may push a screening test that is not indicated given limited life expectancy or patient preference. Another trap: confusing primary and secondary prevention, or assuming a vaccine is contraindicated in older adults when it is recommended. Watch for "more is better" logic-overtesting is a hazard.
Rule of thumb
Ask: Will this result change management within this person's expected lifespan and align with their goals? If not, screening may reasonably be deferred.
Worked example
A 90-year-old with advanced heart failure and a stated goal of comfort asks about colonoscopy. The best response is to discuss that screening is unlikely to change her care given her goals and prognosis, and to focus on symptom management and preventive measures that matter to her-not to schedule the test reflexively.