Health Promotion, Disease Prevention, and Self-Management Support Across Settings
Prevention across settings
Know the levels: primary (prevent disease - vaccines, exercise), secondary (early detection - screening), tertiary (limit disability and restore function - cardiac rehab, fall prevention after fracture). Quaternary - avoiding over-treatment - is increasingly relevant for frail elders.
Screening is a decision, not a reflex. Weigh time-to-benefit against life expectancy and patient goals: colorectal cancer screening generally runs to age 75 with individualized decisions beyond; mammography is biennial from 50 to 74 with shared decision-making after; DXA for women 65 and older; one-time abdominal aortic ultrasound for men who ever smoked; annual low-dose CT for eligible smokers; plus blood pressure, lipids, and depression screening.
Vaccines: influenza annually; pneumococcal conjugate for those 65 and older; RSV for the oldest and at-risk adults; recombinant zoster in two doses from age 50; Tdap every ten years; COVID per the current schedule.
Exercise is the strongest single intervention: multicomponent balance and resistance training reduces falls and preserves function; aim for about 150 minutes of moderate activity weekly plus protein adequate to preserve muscle.
Self-management support differs from teaching: use teach-back, plain language at roughly a fifth-grade level, motivational interviewing, and shared goal-setting. Involve the caregiver as co-manager and screen them for strain. Match setting to need - home health, PACE for dual-eligible frail elders, assisted living, telehealth follow-up.
Trap: assuming health promotion does not apply to frail older adults, or that every eligible screening should be done regardless of burden. Worked example: an 88-year-old with advanced dementia and a two-year life expectancy - prioritize vaccination, fall prevention, comfort, and advance care planning over a screening colonoscopy.