Prevention of health problems in later life

The areas of health promotion and disease prevention for older people have been neglected in medical practice. Many doctors, as well as the general community, believe that for people over 65 years of age it is too late for preventive care. This assumption is incorrect. However, there are a number of issues that are unique to prevention of health problems in later life. The goals of preventive care are broader than the issues of illness and life expectancy. Quality of life, autonomy and maintaining optimal function are equally important concerns for older people. Practising prevention involves not only reducing primary risk factors or screening for disease, but also encompasses psychological, environmental and social issues as these affect health and well-being. In addition, special medical problems require consideration; these include falls, incontinence, confusion, poor mobility and iatrogenic disease which are not the result of one disease process, but have many inter-related causes. Greater prominence should be given to patient education and counselling on these medical, social and psychological issues. General practitioners are ideally placed to initiate prevention as 87% of older Australians visit their GP once a year. While clear recommendations can be given on the effectiveness of some interventions, for others the doctor involved will have to make an informed decision based on individual clinical circumstances. Preventive care in later life is an integral part of good geriatric medicine.