General Screening Recommendations for Chronic Disease and Risk Factors in Older Adults

Issue #100 of

Why

WHY: Chronic diseases, such as arthritis, cancer, diabetes, and cardiovascular disease (coronary heart disease, hypertension, and dyslipidemia),  disproportionately affect older adults and are associated with disability and diminished quality of life. These conditions share many of the same common,  modifiable risk factors, including obesity and physical inactivity. Identification of chronic disease risk factors and early disease detection, through screening, may decrease the burden of chronic disease and protect and promote the health of older adults.

BEST PRACTICES: Assess for individual participation in and results of recommended screening tests during office and clinic visits, and hospital, home care, and tertiary care admissions.

TARGET POPULATION: All younger and older adults.

STRENGTHS AND LIMITATIONS: Although chronic conditions are among the most common and costly health problems, they are also among the most preventable. Risk factor identification, screening, and interventions have been successful in preventing chronic diseases and their associated morbidity and mortality in older adults. However, age limits on screening practices, inconsistencies in risk factor cut points, and bias towards aggressive risk factor reduction in older adults may limit beneficial effects of early detection. For those with multiple chronic illnesses, decisions should be individualized. According to the  American Geriatrics Society (AGS), health screening decisions for older adults should be person-centered and based on the person’s life expectancy, preferences, plan for what the individual may or may not want to do further if screening had positive findings (i.e. potentially invasive testing and/or treatments), as well as degree of burden to the individual.

 

FOLLOW UP: Regardless of the clinical setting and transitions, individuals should have follow-up with their primary care provider to decide on the appropriate lifestyle and/or medication management of risk factors. Individuals should be screened using a holistic perspective in regards to self, family history, setting, and short and long term goals. Careful ongoing assessments of effectiveness of treatment and for its side effects are especially important in older adults.

RISK FACTORS AND SCREENING PROTOCOLS:

1. Screen for chronic disease upon admission of older adults.

2. Educate each person about the importance and benefits of primary preventive care using verbal, written, and electronic material.

3. Initiate and incorporate screening for chronic disease into the electronic health record.

4. Follow up and assure that the health care team complies with protocol.

5. Provide appropriate community referrals and follow up.

MORE ON THE TOPIC:

Best practice information on care of older adults: https://consultgeri.org

American Cancer Society. (2018). American Cancer Society guidelines for the early detection of cancer. Retrieved July 28, 2018 

from https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidel....   

American Cancer Society. (2018). Guideline for Colorectal Cancer Screening: A Summary for Clinicians. Retrieved July 28, 2018 

from https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets....

American College of Cardiology/American Heart Association. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/

ASPC?NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. Journal of the American College of  Cardiology, 71(19), 2199-2269. Retrieved July 28, 2018 from http://www.onlinejacc.org/content/accj/71/19/2199.full.pdf  

American Diabetes Association. (2018). Standards of medical care in diabetes – 2018. Diabetes Care, 41(Suppl 1), S13-S27. 

Retrieved on July 29, 2018 from http://care.diabetesjournals.org/content/41/Supplement_1/S13  

Gardner, K.K., Pomeroy, W., & Arnold, J.J. (2017). Exercise Stress Testing: Indications and Common Questions. American 

Family Physician, 96(5), 293-299A.

Jana, B.R.P. (2017). Prostate Cancer Guidelines. Medscape Retrieved on July 28,2018 from https://emedicine.medscape.com/article/2259453-overviewth    

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus (5 ed.). New York: American Geriatrics Society.  Retrieved July 29, 

2018 at: https://geriatricscareonline.org/ProductAbstract/geriatric-nursing-revie...  

Stone, N.J., Robinson, J.G., Lichtenstein, A.H., Bairey Merz, C.N., Blum, C.B., Eckel, R.H., …, &Wilson, P.W.F. (2014). 2013 

ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129(suppl 2): S1–S45. Retrieved July 28, 2018 from https://www.ahajournals.org/doi/pdf/10.1161/01.cir.0000437738.63853.7a  

U.S. Preventive Services Task Force. (2012). Screening for cervical cancer. Retrieved July 28, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummar...

U.S. Preventive Services Task Force. (2015). Tobacco smoking cessation in adults, including pregnant women: Behavioral and pharmacotherapy interventions. Retrieved July 28, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummar...

U.S. Preventive Services Task Force. (2016). Screening for breast cancer. Retrieved July 28, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummar...

U.S. Preventive Services Task Force. (2016). Screening for colorectal cancer recommendation statement. JAMA, 325(23), 

2564-2575.

U.S. Preventive Services Task Force. (2016 b). Final Recommendation Statement: Obesity in Adults: Screening and Management. 

Retrieved July 28, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati...  

U.S. Preventive Services Task Force. (2017). Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease 

and Colorectal Cancer: Prevention Medicine. Retrieved on July 28, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati...

U.S. Preventive Services Task Force. (2018). Final Recommendation Statement: Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. Retrieved July 29, 2018 from https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati...

Screening recommendations for those of all ages change frequently and are endorsed by multiple organizations. For information related to screening recommendations in older adults, we suggest these organizations and resources. Please note these are only suggestions and are not meant to be a comprehensive list.

American Cancer Society

American College of Cardiology/American Heart Association Task Force on Practice Guidelines

American Diabetes Association

American Geriatrics Society

Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute

National Cholesterol Education Panel (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 

U.S. Preventive Services Task Force

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