INTRODUCTION

For many clinicians, the time taken to care for the immediate needs of elders seems to preclude the ability to address preventive care issues. For others, lack of a perceived benefit may result in missed opportunities to offer preventive care. The clinician who is motivated to learn and apply screening measures in this population will find that most studies and clinical guidelines exclude elders or make no specific recommendation for them. This chapter attempts to help the clinician identify which elders may benefit from screening and current recommendations for implementing these measures; conversely, we also attempt to advise when it is prudent to avoid screening. These recommendations have been obtained primarily from the U.S. Preventive Services Task Force (USPSTF); we also compiled evidence from the medical literature including documentation provided by the Centers for Disease Control and Prevention (CDC).

Recognizably, there are significant time pressures related to patient care. Because of the frequent impracticality of addressing all screening issues at once, the authors would like the reader to consider performing ongoing assessments of their elderly patients by choosing one specific preventive measure to address at each visit.

IMMUNIZATIONS

Immunization efforts in children have been highly successful. In fact, in 1998, the CDC reported that the childhood immunization initiative goals had been met or exceeded during the previous year. Among adults, immunization efforts have been less successful; however, recently the rates of immunization in older adults have been improving significantly.