Personal Journal Assignment-1
Bimala12
HABERAGINGPPT_Ch02.pptxCHAPTER 2 Clinical Preventive Services and Aging
POWERPOINTS TO ACCOMPANY
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Annual physical: addresses health issues before becoming problems versus medical screening excess
United States Preventive Services Task Force
Evaluation of medical screenings
Accuracy
Sensitivity
Specificity
Reliability
Effectiveness
Medical Screenings and Prophylaxis
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#1 killer: lung cancer
23% of nodules identified on CT scan are false positives
Immunotherapy: Checkpoint inhibitors
#2 cause of death in women: beast cancer
Three screening tests
Self-examination
Clinical examination
Mammography
Cancer Deaths
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Recommended at age 40 or 50
Recommended annually versus biannually
Age 75+ consult w/ physician, or no cutoff due to age
Ductal carcinoma in situ
Mammography Controversies
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Latest evidence-based recommendations
Women without risk factors begin age 50
Women age 50 to 74 without symptoms or risk factors undergo mammography every other year
Insufficient evidence for or against screenings over age 75+—consult with personal physician
Physicians should stop teaching breast self-examinations—engenders false confidence
USPSTF and Mammogram Recommendations
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Versus benign prostatic hyperplasia
Second to lung cancer in men’s cancer deaths
Cautions with prostate-specific antigen (PSA) screening
Treatment options for malignant prostate
Drug therapy, surgery, radiation, etc.
Side effects and adverse outcomes
Prostate Cancer
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Third leading cause of death in men and women
Increased risk with age
Screening recommendations for age 50+
Fecal occult blood test, fecal immunochemical test (FIT), Cologuard
Sigmoidoscopy
Colonoscopy
Colorectal Cancer
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Skin cancer (most common cancer)
Half of skin-related deaths occur in age 65+
Most common: basal and squamous cell
Most lethal: melanoma; checkpoint inhibitors
Cervical cancer
Why Medicare coverage?
Pap test
Human papillomavirus (HPV)
Other Cancer Screenings
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Thyroid gland
Hyperthyroidism
Hypothyroidism—Synthroid overuse
Thyroid cancer screening
USPSTF versus American Thyroid Association
South Korean National Screening Program
Other Cancer Screenings—cont’d
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Recommendations
Women 50 to 59 years
Women without a uterus: low-dose estrogen
Women with a uterus: progesterone and estrogen
All women (if necessary): low dose and periodic monitoring
Risks
Increased blood clot risk in legs and lungs
Increased breast cancer risk when taken 5+ years
Menopause: Hormone Replacement Therapy (HRT)
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Responsible for most deaths
Hypertension
Systolic blood pressure level is age related
Prehypertensive: 121 to 139
Blood pressure threshold
Age 80+ controversy
AHA/ACC recommends 130; USPSTF—140
Treatment
High Blood Pressure
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Who is affected?
More than 28 million Americans
80% are female
Screening recommendations
Routine densitometry screening beginning at age 65 for all women
Frequency unclear
Routine screening of males at some point?
Osteoporosis
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Osteopenia versus Osteoporosis
Treatment
Calcium and vitamin D supplements with osteopenia: caution, kidney stones
Bisphosphonates for osteoporosis
FDA cautions against long-term use without physician monitoring
Weight-bearing exercise for everyone
Osteoporosis—cont’d
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Fatty substance manufactured by the liver, supplemented through diet
Measurements
Low-density lipoproteins (LDL)
High-density lipoproteins (HDL)
NCEP guidelines
Statins: Benefits and side effects
Cholesterol
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LDL targets
Cholesterol—cont’d
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Guidelines for statin use and PCSK9 inhibitors
Guidelines for taking PCSK9 inhibitors: statin intolerance or goal of LDL level below 70 mg/dL
Statin concerns for primary prevention: age 75+, high dose, interactions, intolerance
Cholesterol—cont’d
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Type 2 diabetes (formerly adult-onset diabetes)
Related to obesity and inactivity
Refers to increased resistance to insulin
Diabetes: ≥126 mg glucose/dL
Screening recommendations
ADA recommendation: >45 years: every 3 years
USPSTF recommendation: >45 years + risk factors: every 3 years
Diabetes
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Prediabetes
Between 100 and 125 mg/dL
Lifestyle changes twice as effective as medication
Diabetes Prevention Program launched in 2018
Medicare's Diabetes Prevention Program launched in 2018
Diabetes—cont’d
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Hearing loss prevalence 50% in 70s; 80% in 80s
Presbycusis is age related
Hearing aid resistance and benefits
Blindness is one of the most feared disabilities
Presbyopia
Cataracts
Glaucoma
Macular degeneration
Oral health and edentulism
Hearing, Vision, and Oral Health
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Infects 1 in 30 baby boomers
Is a blood-borne virus
CDC screening recommendations
Drug treatment effective, but expensive
Improvements: Sovaldi, Harvoni, Mavyret
Hepatitis C
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Screening dogs (and cats)
Immunizations
Influenza
Pneumonia
Tetanus
Shingles: Zostavax versus Shingrix
Screenings and Immunizations
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Aspirin prophylaxis
Baby aspirin used as blood thinner for prevention of heart attack and stroke, recommended as secondary prevention
Insufficient evidence for use as primary prevention for age 70+, ACC/AHA no longer recommends in 2019
Risk of gastrointestinal bleeding
Polypill and Polymeal
Aspirin Prophylaxis and Polypill
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Interventions
Annual wellness visit
Cardiovascular and diabetes screenings
Lung, cervical, prostate, and colorectal cancer
Densitometry
Mammogram
PSA
Medicare Prevention
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Interventions (cont.)
Immunizations
Smoking cessation
Obesity screening and counseling
Depression screening
Alcohol misuse screening and counseling
No deductible or copay
Medicare Prevention—cont’d
