Ethical aspects of primary preventive measures among the institutionalized elderly

For the interested physician, the primary prevention of medical illness is often considered a luxury or an optional exercise. This report illustrates the position that physicians caring for the institutionalized elderly have a strong ethical and perhaps legal obligation to institute primary preventive strategies, in view of their responsibilities for total care of the patient. As an example related to cardiovascular mortality and morbidity, primary preventive strategies directed at cigarette smoking and immobilization appear to be clearly indicated. The absence of preventive strategies could be construed as acceptance of intervention designed to increase morbidity and mortality.