aging
Module 2: Clinical Preventive Services
Robin Majeski, PhD, RN, The Erickson School, UMBC
Learning Objectives
1.Describe basic medical screenings such as the annual physical exam and screenings for lung, breast, prostate, and colorectal cancer, osteoporosis, blood pressure, and cholesterol.
2. Discuss the accuracy, reliability, and effectiveness of screenings.
3. Analyze how Medicare prevention helps older adults age well.
Medical Screenings*
Tests for the early detection of disease.
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Accuracy, Reliability, and Effectiveness of Screenings*
Accuracy: sensitivity and specificity of screening.
Sensitivity: % of those who have a disease and tested positive for the medical condition or disease with a screening
Specificity: % of those who do not have a medical condition and who correctly tested negatively for this condition.
**Haber, D. (2020). Health promotion and aging. 8th edition.
Wellness Program Paper DUE on 5/10 at 11:59pm EST.
Review the step-by-step instructions for this assignment on Bb.
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Accuracy, Reliability, and Effectiveness of Screenings*
Reliability: the ability of a screening to have the same result when tested at different times.
Effectiveness: Whether a screening is worth the cost in terms of time, effort, and money.
*Haber, D. (2020). Health promotion and aging. 8th edition.
Wellness Program Paper DUE on 5/10 at 11:59pm EST.
Review the step-by-step instructions for this assignment on Bb.
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Annual Physical Exam*
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Advantage: early detection of problems
Disadvantage: Can result in tests being recommended when unnecessary.
Recently, annual PEs replaced by periodic reviews based on age, sex, and risk factors for disease.
Lung Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Lung cancer is a malignant tumor in the lungs.
2015: Medicare covers yearly lung cancer screenings/scans for those with long history of heavy smoking up to age 77.
Breast Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Breast cancer is 2nd leading cause of cancer mortality among women.
Breast Cancer: 3 Screening Tests*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
**
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Breast self-exam: Recommended by American Cancer Society and doctors
Clinical breast exam (done by health professional) recommended each year for women age 40+
Mammography: begin at age 50. Recommended every other year from age 50-74 if no risk factors or symptoms.
Prostate Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Prostate cancer is second most common cause cancer death in men.
Prostate specific antigen screening (PSA): detects abnormally high levels of protein made by prostate.
PSA: USPSTF: Recommendation against routine screening.
Colorectal Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Fecal occult blood testing: USPTF recommended but has high % of false positives. Annual test covered by Medicare.
Digital rectal exams: limitations with detection of cancer.
Sigmoidoscopy: recommended every 4 yrs for average risk patient over age 50. Covered by Medicare for every 4 yrs.
Colorectal Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Colonoscopy: best test for colorectal cancer screening. Medicare coverage for every 10 yrs.
Cervical Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Cervical cancer is malignancy in cervix.
Pap smear recommended for women beginning at age 21 and one every 3 years after 2 normal annual tests. Covered by Medicare every 2 yrs.
Cervical Cancer Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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DNA test for HPV (most common cause of cervical cancer) recommended by USPSTF with Pap test recommended every 3-5 yrs for women age 30-65.
High Blood Pressure*
Blood Pressure
Systolic blood pressure: Pressure of blood moving through the blood vessels as the heart pumps or contracts.
Diastolic blood pressure: Pressure of blood moving through the blood vessel as the heart rests or between contractions.
High Blood Pressure*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Abnormal pressure of blood moving through the blood vessels
Silent killer
Blood Pressure Test
Blood pressure reading*
Osteoporosis Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Osteoporosis is excessive loss of bone mass leading to increased risk of fracture.
Post-menopausal women are those most affected.
Osteoporosis Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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USPTF recommends bone densitometry screening starting at age 65 but is unclear about how frequently these should be done.
Medicare covers bone densitometry every 2 yrs.
Osteoporosis Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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For women age 50-64.5 yrs, assessment based on risk factors.
Cholesterol Screening*
Wellness Program Paper DUE on 5/10 at 11:59pm EST.
Review the step-by-step instructions for this assignment on Bb.
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LDL: low density lipoprotein (“bad” cholesterol)
HDL: High density lipoprotein (“good” cholesterol)
Cholesterol Screening*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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LDL: low density lipoprotein (“bad” cholesterol): may result in build up of plaque and possible blockage in the blood vessels.
HDL: High density lipoprotein (“good” cholesterol): Gets rid of LDL cholesterol.
Recommended LDL Cholesterol Levels*
| < 70 | For very high risk patients |
| <100 | For high risk patients |
| 100-129 | For moderate risk patients |
| 130-159 | For low-risk patients |
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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2013 Cholesterol Guidelines: Statin Recommendations*
*Haber, D. (2020). Health promotion and aging. 8th edition. New York: Springer
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Patients with diagnosed atherosclerosis.
Patients with LDL levels at or above 190 mg/dL
Patients with Type 1 or 2 diabetes and LDL of at least 70 mg/dL
2013 Cholesterol Guidelines: Statin Recommendations*
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Patients with 10 yr risk of cardiovascular disease of at least 7.5% , an LDL of at least 70 mg/dL, and between ages 40-75.
Important Medicare Prevention*
| One Time Welcome to Medicare Physical | Within 6 mos of enrollment in Medicare: No co-pay or deductible |
| Annual Wellness Visit | No deductible or co-pay |
| Cardiovascular screening | Every 5 yrs, no deductible or co-pay |
| Cervical cancer screening | Every 2 yrs, no deductible or co-pay |
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Important Medicare Prevention*
| Densitometry (for osteoporosis) | Every 2 yrs, no deductible or co-pay |
| Diabetes screening | Annually. For those with pre-diabetes, every 6 mos. No deductible or co-pay. |
| Mammogram | Annually, no deductible or co-pay |
| Prostate cancer screening | Annually, no deductible or co-pay |
*Haber, D. (2020). Health promotion and aging. 8th edition.
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Some Important Medicare Prevention*
| Immunization | Annual flu vaccine, 2 pneumococcal vaccinations covered one time each, after 5 yrs, depends on risk. No deductible or co-pay |
*Haber, D. (2020). Health promotion and aging. 8th edition.
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