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Geriatric health maintenance

Author
Mitchell T Heflin, MD, MHS
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

The profile of aging in the United States has changed dramatically over the last century. The average life expectancy at birth has increased from 47 years in 1900 to nearly 79 years in 2014. By 2030, the percentage of the population over 65 years of age will exceed 20 percent, or over 70 million people [1]. Worldwide, the number of adults over 60 years of age will top 2 billion by 2050 and will constitute over 20 percent of the world's population [2]. Projections based on current growth patterns indicate that the vast majority of these older adults will reside in less-developed countries (1.6 billion).

Definitions of health and wellbeing in late life have changed with the increase in life expectancy. Heart disease, cancer, and stroke have become the leading causes of death among older adults, while deaths due to infection have decreased. Adults surviving into late life suffer from high rates of chronic illness; 80 percent have at least one and 50 percent have at least two chronic conditions [1]. There is a strong association between the presence of geriatric syndromes (cognitive impairment, falls, incontinence, vision or hearing impairment, low body mass index [BMI], dizziness) and dependency in activities of daily living (relative risk 2.1 for one condition; 6.6 for three or more conditions) [3].

Decline in function and loss of independence are not an inevitable consequence of aging. Given the high prevalence and impact of chronic health problems among older patients, evidence-based interventions to address these problems become increasingly important to maximize both the quantity and quality of life for older adults.

The Assessing Care of Vulnerable Elders (ACOVE-3) project identifies quality indicators in the care of older adults, including recommendations for routine health maintenance [4]. Clinician experts serving as authors for this project have critically evaluated the evidence supporting these quality indicators. Their review, in conjunction with other sources, is used in the development of this discussion.

This topic offers a brief discussion of office-based assessments to identify and address common problems that are amenable to prevention or amelioration in older adults. An overview of preventive medicine for the general population is presented separately. (See "Preventive care in adults: Recommendations".)

                                              

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