photorandy2023 Aging Gracefully

Aging Gracefully and Living Comfortably in Your Later Years-Chapter Three-Preventive Care

The Critical Importance of Preventative Care in Aging Populations

You get one body and you want to keep it moving and functioning. Getting older shouldn’t mean you stop. As individuals age, their healthcare needs evolve, making proactive preventive strategies essential in maintaining health, independence, and quality of life. 

Why is preventative health care an important priority in geriatric medicine?

Preventive health care is essential in geriatric medicine because it focuses on early detection and management of health issues before they become severe. Regular check-ups, screenings, and immunizations help maintain independence and improve quality of life for older adults by addressing health problems proactively. It also reduces the risk of complications from chronic diseases like heart disease, diabetes, and cancers. Additionally, preventive care encompasses health education, fall prevention, and medication management, all supporting aging healthfully. By actively managing health, seniors can avoid costly emergency interventions, which leads to better health outcomes and lower healthcare expenses. Overall, prioritizing prevention fosters healthier, more active aging.

What is the role of prevention in healthcare?

Prevention is a cornerstone of effective healthcare because it reduces the risk of developing diseases and disabilities. It involves implementing evidence-based services such as vaccinations, screenings, and health assessments to detect health concerns early. These efforts help improve treatment success and prevent disease progression. Initiatives like Healthy People 2030 emphasize increasing access to preventive services to close disparities based on age, race, and economic status. Strategies such as team-based care and removing financial barriers enable more people to benefit from prevention. Ultimately, prevention promotes healthier populations, reduces long-term healthcare costs, and enhances overall well-being.

What is the impact of preventive care on health outcomes, longevity, and quality of life in seniors?

Preventive care significantly improves health results, extends lifespan, and enhances life quality among seniors by enabling early intervention for chronic conditions. Regular screening, immunizations, and health assessments help prevent the onset or worsening of diseases such as hypertension, diabetes, and cancers. This early management reduces hospitalizations and disability, supports functional independence, and maintains mental health. Evidence indicates that seniors who engage in preventive measures experience higher satisfaction with aging and tend to live longer healthier lives. Personalized prevention strategies that incorporate lifestyle modifications, nutrition, and physical activity further strengthen these benefits. Overall, proactive prevention helps seniors stay active, independent, and fulfilled.

Why is preventative care significant in managing health risks among older adults?

Preventative care plays a pivotal role in managing health risks for older adults by enabling the early detection and treatment of chronic illnesses. Regular screening tests, immunizations, and health evaluations help identify health threats before symptoms emerge, preserving health and independence. Investing in prevention not only improves individual quality of life but also helps lower healthcare costs by avoiding advanced disease approaches like hospitalization. Community programs promoting physical activity, smoking cessation, and balanced nutrition reduce disparities and support overall well-being. Proactive preventive strategies empower older adults to live actively and reduce their risk of illness, thus supporting a healthier aging process.

What diseases can be prevented through preventative measures, and how?

Many diseases such as cancers, infectious diseases, and chronic conditions like cardiovascular disease and diabetes can be prevented through targeted strategies. Vaccinations—including influenza, pneumonia, shingles, and COVID-19—offer protection against infectious illnesses. Regular screenings for cancers, cholesterol, and blood pressure facilitate early diagnosis and treatment. Lifestyle modifications like quitting smoking, eating a nutritious diet, engaging in physical activity, managing stress, and ensuring proper sleep are vital components. Utilizing electronic health records and integrated care teams helps identify risk factors early. Managing blood pressure, high cholesterol, and blood sugar effectively reduces the likelihood of developing serious diseases. In summary, early intervention and healthy habits are key to lowering disease incidence among seniors.

What is the role of prevention in healthcare?

Prevention is fundamental in healthcare because it helps reduce the likelihood of developing diseases, disabilities, and premature death. By providing evidence-based preventive services—such as screenings, immunizations, and health counseling—healthcare systems can detect health issues early when they are more treatable. Efforts like Healthy People 2030 aim to increase the accessibility and uptake of these services, addressing disparities related to age, race, and socioeconomic status.

Implementing strategies like team-based care and removing financial barriers, such as copays, encourages more individuals to access preventive care. Ultimately, prevention not only improves individual health outcomes but also reduces long-term healthcare costs by avoiding costly emergency interventions and managing chronic conditions proactively.

The Framework for Personalizing Preventive Care in Older Adults

One of the best ways to stay on the move is with preventive health care. Some screenings and tests can help your doctor find problems early, before they cause bigger problems.

Don’t let cost keep you from having these tests. Most health plans, including Medicare, pay for preventive tests. Your doctor can help make the case, if need be. They may also be able to send you to free or low-cost programs.

  1. Regular Screenings:
  • Blood Pressure Checks: High blood pressure can cause a heart attack, a stroke, eye problems and kidney problems without you even knowing your blood pressure is high. That’s why it’s important to get your blood pressure checked, even if you don’t think you have a problem. If your blood pressure is lower than 120/80, at least once every year is usually fine. If it’s higher, your doctor probably will want to check it more often.
  • Cholesterol Screening: Heart disease is one of the top causes of death in the U.S. One of its main risk factors is high cholesterol. After you turn 20, you should start getting your cholesterol tested at least once every 4 to 6 years. A simple blood test shows your levels and risk for heart disease. As you age, your risk for heart disease goes up. If you’re in your 50s, it’s important to keep getting screened.
  • Diabetes Screening: Nearly 10% of all Americans have diabetes, and nearly 28% of those are undiagnosed. Uncontrolled diabetes can cause complications such as blindness, kidney disease, and the need for limb amputation. Regular screenings are crucial, especially if you have risk factors like obesity or a family history of diabetes.
  • Mammogram: Experts agree that this is the best way to find breast cancer early. There’s some debate about how often you should get one. The U.S. Preventive Services Task Force says all women between ages 50 and 74 should have a mammogram every 2 years. The American Cancer Society says if you’re over 40, you should get one each year. Talk with your doctor to determine the best schedule for you, based on your family history and other reasons.
  • Colon cancer screening: Colon cancer is the second-leading cause of cancer deaths in the U.S. When you turn 45, your chance of getting it goes up. So unless you’re at above-average risk, your doctor will probably recommend screenings once you reach that half-century mark.
    • Tests can help detect colon cancer early. How often you’re screened depends on which tests you and your doctor decide you should have, and what the results are. Common screenings include:
    • Colonoscopy, usually given once every 10 years
    • Fecal occult blood test, which most folks get annually
    • Sigmoidoscopy, which most get every 5 years, combined with a fecal occult blood test every 3 years
    • Multi-targeted stool DNA testing, which looks for DNA mutations that may signal an issue
    • CT colonography, which uses X-rays to take pictures of your colon. The pictures are then put together by computer to help your doctor see if anything’s wrong.
    • Sigmoidoscopy and colonoscopy can also help prevent cancer. During these, your doctor may find and remove precancerous polyps from your colon.
  •  Pap test: This test checks for cervical cancer, which is easy to treat when caught early. Although your risk of cervical cancer goes down with age, your need for routine Pap tests doesn’t stop with menopause. The U.S. Preventive Services Task Force says women ages 21 to 65 should have a Pap test every 3 years. You could also choose to get screened every 5 years once you turn 30 instead using human papillomavirus (HPV) testing or a combination of the Pap and HPV tests if both tests are negative the first time you take them. If you have a higher risk of cancer, you may need a Pap test more often. Your doctor can recommend what’s best for you.
  • Bone mineral density scan: This checks your risk for osteoporosis, a condition that weakens your bones. It’s recommended for all women at age 65. If you’re at high risk, your doctor may want you to do it earlier.
    • This screening also may help men ages 70 and older.
  • Abdominal aortic aneurysm screening: Experts say you should get this if you’re a man 65 to 75 who’s smoked at any point in your life. It’s an ultrasound that looks for an enlarged blood vessel in your abdomen that can cause severe bleeding and death if it ruptures. If your blood vessel is enlarged, surgery can often fix it. If you have a family history of this, talk to your doctor as they may recommend screening.

  1. Vaccinations:
  • Flu Shot: Recommended annually for everyone aged 6 months and older.
  • Pneumonia Vaccine: Recommended for those aged 65 and older. A series of two different vaccines is now recommended. You should get them if you’re 65 or older, and if you have:
    • Diabetes
    • Liver disease
    • Asthma
    • Any other type of lung disease
    • Problems with your immune system
  • Shingles Vaccine: Recommended for individuals aged 50 and older. 
  1. Healthy Lifestyle Choices:
  1. Mental Health:
  1. Annual Wellness Visits:

Towards a Healthier Aging Process

In conclusion, preventative care is the cornerstone of long-term health management for seniors. Its comprehensive approach—incorporating screenings, vaccinations, lifestyle adjustments, and technological interventions—serves to detect health issues early, manage chronic diseases effectively, and promote overall well-being. Embracing personalized and proactive healthcare strategies not only extends longevity but significantly enhances quality of life, allowing older adults to age in place with independence and vitality. As healthcare systems evolve, prioritizing accessible, patient-centered preventative services will be critical in fostering healthier aging populations and reducing healthcare costs across communities.

Below is the transcript of a podcast on preventative care:

Dr. Christina Chen: This is “Aging Forward,” a podcast from Mayo Clinic about geriatric medicine and the science of healthy aging. Each episode, we explore new ways to take care of ourselves, our loved ones, and our community — so we can all live longer, fuller lives.

I’m Dr. Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota. In this episode we are talking about a guide to health screening and prevention throughout the aging journey.

Our guest today is Dr. Danny Sanchez Pellecer, who is triple board certified in internal medicine, geriatrics, and palliative medicine. He is one of our staff members in the department of community internal medicine at Mayo Clinic in Rochester. Welcome and thanks for joining us today, Dr. Pellecer.

Dr. Daniel Sanchez Pellecer: Thank you very much for having me. It’s a pleasure being here.

Dr. Christina Chen: We always like to start with the basics and understand basic terminology of preventive health versus health maintenance. What’s the difference there?

Dr. Daniel Sanchez Pellecer: There’s really no difference between health maintenance and preventive health. I would say that we use these terms interchangeably. At the end of the day, they basically lead to the same process. Just a group of different types of testing or interventions that are specifically designed to help prevent things before they happen, or try to find things before they get too bad.

Dr. Christina Chen: At a high level, what would you say are the general benefits to preventive health screening for older adults? What are we trying to prevent in that population?

Dr. Daniel Sanchez Pellecer: Overall, I would say that the main objective of preventive health in older adults is improving their quality of life. At the same time, reduce cost — not just for patients themselves, but also for the healthcare system. Because prevention is going to be significantly cheaper than curing a disease.

Dr. Christina Chen: What you’re saying is that they may have hypertension, diabetes, or whatever health condition, but there’s still a lot that can be done to prevent things such as hospitalizations, falls, or worsening of a condition that could lead to those situations.

Dr. Daniel Sanchez Pellecer: That’s right. I definitely see lower rates of hospitalizations, less healthcare expenditure when it comes to money, and usually when we catch cancer in patients that have their normal follow-ups, we usually catch it early. It never gets that bad. In fact, many times we can get patients in complete remission, meaning that we are able to cure them, as long as we catch things on time.

Dr. Christina Chen: I could see why in the younger adult population and average adult population we want to get ahead of that as early as possible to prevent disease occurrence. How is that different for older adults who have perhaps already developed a chronic disease? How does preventive health look different for them?

Dr. Daniel Sanchez Pellecer: I would say that there’s a lot of slowing down of the metabolism and slowing down of all the systems as we get older. There’s going to be a lot of chronic conditions that will probably not present until later in life.

Usually, we like to start around age 55 for certain things, age 65 for certain others. As an example, when we talk about weak bones or osteoporosis — that’s not something we typically will see in someone young — that’s something that happens after our metabolism has slowed down and we’re not producing much bone density.

Therefore that is more of a process or a screening that we worry about more in women once they reach 65 years of age.

Dr. Christina Chen: You mentioned changes in metabolic health and bone health. Are there any other specific risk factors that make preventive health more crucial in the aging process?

Dr. Daniel Sanchez Pellecer: The other big one will be the immune system. The immune system tends to slow down as well. The immune cells take them longer to really try to alleviate any threats. That makes older adults more vulnerable to infections.

At the same time, it is our immune system that tries to protect against abnormalities in your cell proliferation. That slowing down of your immune system can also lead to development of cancers, which we also tend to see as we get older.

Dr. Christina Chen: I often do see some people who come in their late 60s and 70s for the first time getting their preventive health screening. By that time, they’ve developed a multitude of other health conditions.

I’m just wondering, have you noticed common barriers for older adults as they access early preventive health? Why do some of them get their cares too late?

Dr. Daniel Sanchez Pellecer: There could be several reasons, and I would say here in the United States, healthcare has become very expensive. Lack of insurance coverage is probably a big one. Also, it’s very well known that rural areas tend to have less access to healthcare in general, and preventive health is no exception.

Human nature tends to be more of a — we don’t like prevention very much. We are very good adapters. We adapt to crises very well, but we’re not very good at preventing things.

Dr. Christina Chen: Yeah, more reactive. What about challenges across different demographic groups?

Dr. Daniel Sanchez Pellecer: The cultural differences may actually impact how well received certain preventive services are. Certain communities, especially Indian-American communities, may have some mistrust in the medical community and they may not be as receptive to, for example, receiving a vaccine.

Then, of course, you’re here in Minnesota, specifically in Rochester, we have our farming community where they’ve been working really hard their entire lives, and they’re very tough. They don’t feel that they need certain things.

They’re also somewhat resistant to receive vaccinations or even do testing. They always come with an attitude that, “Hey, if I’m going to get cancer, then that’s fine, I’ll get it.”

Again, a little bit back on into that mentality of, “I’m going to react to a crisis when it happens. If the crisis hasn’t happened, I don’t need to worry about it.”

Dr. Christina Chen: Yeah. That’s why it’s important to explore the person’s beliefs and values and whatever misinformation that they have heard or perceive on their own, to help educate them in that aspect of understanding that there are benefits.

Dr. Daniel Sanchez Pellecer: In reality, there’s no better way to do that than really establish a good relationship with each patient. The only way to do that in modern medicine is to have patients come back, at the very least, on a yearly basis.

Even if there’s nothing wrong, everything is okay — but at least just to touch base. There’s always something. That’s where we try to counsel patients in terms of what vaccinations, what testing would we recommend to initiate some preventive services and alleviate some of the mistrust that they may have or hesitations regarding testing or vaccinations. What can we do to revert those things?

Dr. Christina Chen: You’re always so good with having these conversations. I feel like you’re the pro at that.

Dr. Daniel Sanchez Pellecer: I try to, yes.

Dr. Christina Chen: What would you say would be the most important screenings older adults should be having on a regular basis to, again, prevent these things from happening and so that we’re not so reactive?

Dr. Daniel Sanchez Pellecer: I will probably focus on colonoscopies, mammograms, prostate cancer screening, and bone mineral densities. Now, how often depends on the result. The more straightforward is mammograms. Usually, USPSTF recommends every two years. Here at Mayo Clinic, we actually recommend it yearly.

I may space it out more in my older patients past 80, 85 years of age. If we decide that it’s still okay to continue, I will probably space it every couple of years. With colonoscopies, it really depends. If the colonoscopy is completely normal and we didn’t find anything, then it’s 10 years.

But then it may be three years. It may be five. It may be five to seven, depending on how many polyps were found, how many were removed, and what the pathology shows. When it comes to bone mineral density, similarly, it depends on the results. If the bone mineral density is really bad, but not necessarily in the osteoporotic range, then we may want to repeat that in three years.

However, if it’s more in the mid-range, then we may wait a little bit longer. Usually, as a general rule, I don’t like to wait more than five years to repeat it. There’s some specific testing that is recommended in older adults that have certain risk factors.

I will say the biggest one is older adults that smoke. Another important screening test is an ultrasound of the big vessel aorta to make sure that there’s no development of an aneurysm.

That one is important, because if we don’t catch that on time and an aneurysm bursts, there’s really no time to treat that. Patients can die very suddenly if that happens. It’s such an easy, cheap test: Our technology these days has gotten to a point where we can do this with relatively lower rates of side effects or complications.

Dr. Christina Chen: You mentioned colonoscopies, mammograms, prostate screening, bone density scans, and if you look at the USPSTF general guidelines it mentions when to start, and then afterwards it gets muddy. After a certain age, it’s like, “Oh, just talk to your doctor and see what’s the best for you.”

It doesn’t really give us a lot of clear guidance about when to stop. How do you approach that in the absence of official recommendations? When is an appropriate time to stop screening?

Dr. Daniel Sanchez Pellecer: That’s probably the question that got me very interested in this topic of prevention. I would say that the decision of when to stop has to be an individual one. Age is the only thing to consider. There’s many other components to be considered before we decide when to stop.

Apart from age, those things will include the patient’s preference, the patient’s family history, and most importantly — what is the life expectancy of a particular patient? The reason that’s important is because we have determined that certain screening tests will have a specific time period where we are going to observe a survival benefit.

I would say that if a patient is sick enough that their life expectancy is potentially less than 10 years, there could be more damage or more side effects if we do a specific screening test versus stopping.

To the contrary, if we think that the estimated life expectancy exists 10 years, there is a significant benefit of continuing cancer screening. My approach in the clinic is, have an honest discussion with the patient and see what is their preference; use that as my guide on where to go next; and if the patient’s preference is towards continuing screening, then I try to estimate the life expectancy.

We have different tools that we use to do that. Once I have that, then I put everything in a balance, have a discussion with the patient and we together make the determination whether it’s appropriate to stop or not.

Unfortunately, there’s no recipe. That’s probably why there’s no guidelines, right? Because the topic is way more complicated and there’s so many things that you have to take into account. At the end of the day, the final decision is one that you’re going to formulate after you have an honest conversation with your doctor.

Dr. Christina Chen: That’s really helpful, and I agree: I have so many patients who are in their late 80s to 90s who are just doing so great. They are living their best life. They’re so functional. It’s like, “Wow, I could see you live in another 10 years into your hundreds.”

You’d be surprised. A lot of times they’ll tell you, “I’ve gone through my screening. I just don’t want to go through anymore.” That’s their decision.

Dr. Daniel Sanchez Pellecer: That’s okay. That’s okay. I have had those situations as well, where I see and I estimate their life expectancy, and it’s actually more than 10 years. If their preference is still, “No, I think I would like to stop,” that’s perfectly reasonable, as long as they have understood the rationale why we would still recommend continuing.

The other way around as well, right? Many times there’s patients that are significantly sicker, they’re in and out of the hospital, have five different chronic severe medical conditions, and they still want to continue doing colonoscopy, still want to continue doing mammograms.

In that case, I have to sit down with them, and have that difficult conversation of disclosing, “Well, your life expectancy is probably not as high as we would hope. That would potentially mean that if I continue doing colonoscopies on you, I may be hurting you more than helping you. You may have a very bad side effect from anesthesia or you could have a complication or a bowel perforation.”

At the end of the day, if the patient decides, “You know what? That’s okay, that’s a risk I’m willing to take,” we always have to respect a patient’s wishes. As long as it’s within the appropriate risk, then many times I have ordered colonoscopies in these scenarios.

Dr. Christina Chen: Let’s move on to vaccines and immunizations. We’ve come a long way with vaccines and public health efforts and it’s saved a lot of lives over the years. There’s been a lot more vaccines that have been developed in recent decades. Which ones would you say are the most important for older adults?

Dr. Daniel Sanchez Pellecer: It’s a very important topic. Going back to what we said at the beginning when our immune system slows down, right — that makes older adults more susceptible to severe infections. One of the most common conditions that actually kills older adults is pneumonia. I would say pneumonia is one of the vaccines that is very important for older adults to receive.

Pneumonia has different strains. Now each five years or so we have a new pneumonia vaccine that covers more strains. We have a new one that came out two years ago, it’s called PCV20 and that’s the one currently being recommended in patients that are 65 years and older.

The other big one and the one that I think — if there are patients out there that are hesitant to receive it, I will ask them to just think twice — is the shingles vaccine. There’s been a relatively newer shingles vaccine version since 2017.

The newer vaccine has a completely different mechanism — and not only has the advantage that we can use it in patients that are immunosuppressed — but the efficacy in the studies is significantly higher than the older vaccine. It reaches up to 80 percent in older patients.

The most important thing about this new vaccine is that it is really good in preventing postherpetic neuralgia, which is the pain that comes after getting shingles. That pain, no one wants to get it. It is very difficult to treat.

The medications available are not great for it, and it’s very debilitating. If we have something that would potentially help you prevent getting the pain, then that’s great.

Dr. Christina Chen: Yeah.

Dr. Daniel Sanchez Pellecer: Then the third, a new vaccine for older adults is the RSV vaccine. RSV came out last year. We have two different types. Both seem pretty effective. One interesting fact about this vaccine is that — contrary to, for example, the flu and the COVID vaccine that we need to get every year, because these are respiratory viruses — so far, one single shot has been enough, at least, for three years.

That may change. The studies are ongoing, but it’s another good vaccine to recommend and consider in patients older than 65. The RSV virus is another big killer. Many times it can cause severe disease that can land patients in the hospital. Many times in the ICU.

Dr. Christina Chen: Yeah, you’re so right about the pneumonias because GI and respiratory tract are the main organ systems where we’re constantly exposed to the outside environment.
The immune system and these organs need to be robust and prepared to handle these situations. I’m glad you started with that understanding.

From my perspective, I had shingles, even in my 40s. It was the most painful — In fact, I still occasionally will have those postherpetic neuralgia symptoms. It’s something that I always remind people: It’s not just the event. It’s the after effect that stays with you.

Dr. Daniel Sanchez Pellecer: Many times I get questions from patients, “Oh, I already got shingles. I don’t need to be vaccinated.” There’s actually a lot of benefit from getting vaccinated, even if you had shingles in the past.

Again, each time that you get vaccinated, you get better protection, particularly against that pain that comes afterwards. Another thing to consider is that unlike several other vaccines, the new shingles vaccine is a series of two shots that comes. Then you should receive it two months apart, usually.

Another big question that I get when it comes to shingles vaccine is, “I just got shingles. When can, or should I get my vaccine?” Usually that time frame is two to three months is what most experts recommend.

Dr. Christina Chen: There are four million older adults who are considered completely homebound, or mostly homebound, meaning that they can’t leave the home without extreme effort or needing assistance. How do we improve vaccine access to people who are in that situation, or in more rural areas where they may not have access to healthcare services?

Dr. Daniel Sanchez Pellecer: There’s no right answer to that. We need to make better efforts at trying to cover this vulnerable population. We have a homebound program to get vaccinations to these vulnerable patients. However, the program we have here is not necessarily something that has been replicable in other parts of the country.

At this point, we need funding and initiatives to help these programs grow in different communities, because it needs to be a more sophisticated system that is well thought of.

To do that, what you need is money and you need staff, too, because by administering a vaccine you need someone that is trained to do it. It’s definitely a very complicated problem that does not have an easy solution.

Dr. Christina Chen: I wish they had a mobile vaccine clinic or something. Maybe they have that already. I’ll have to look into that.

Dr. Daniel Sanchez Pellecer: New York City actually has one. Usually they go neighborhood to neighborhood. Even though it brings the research closer to different communities, my understanding is that the staff there does not necessarily go to patient’s homes, which is ultimately what we would need to deliver this service. But yeah, it will be a very nice problem to tackle.

Dr. Christina Chen: We should just rent a van and grab some volunteers; get some extra vaccines, and just drive around Rochester and get it to people who need it.

Dr. Daniel Sanchez Pellecer: I can tell you what will happen in my home country, Guatemala. They will use medical students to do this.

Dr. Christina Chen: Oh yeah. We’ve got medical students who would be willing to do that for sure. Let’s move on to some things that we often don’t think about: screening our cognitive and brain health and our functional health. I feel like that’s not often seen as routine preventive health in the average adult population. Can you speak to that a little bit?

Dr. Daniel Sanchez Pellecer: The barrier or the challenge that we’ve seen and why this is not more widely done is probably because, if you look at the USPSTF guidelines, they themselves actually recommend against routine screening for cognitive disorders.

The main reason for that, or the main reason we haven’t observed a benefit in studies, is because we don’t have treatments. Or we don’t have good treatments, at least. There’s no good cost-benefit, I guess, that the USPSTF has observed.

What they are recommending is perhaps it’s better that you spend your time trying to counsel patients on vaccines and doing colonoscopies and mammograms, because then we can actually have something solid to build outcomes on. The reality is that screening for cognitive impairment definitely takes time.

With that being said, the fact that we don’t have good treatment doesn’t mean that we shouldn’t be looking for this, detecting it, diagnosing it, because there’s other things that we can do, like counseling family members, or pair patients and families with resources in the community that can potentially improve the patient’s quality of life.

What I always do is, once every other year, I like my patients to come with their significant other because the significant other can tell you immediately whether something’s wrong or not.

There’s certain screening tests where you can have two or three questions that are very quick that our nursing team can do when patients are being groomed.

I will say that cognitive assessment or screening is particularly important in older patients that start struggling with falls.

That may be the initial presentation of a cognitive problem. As a routine, any patient that starts falling, I use that as an excuse: “You know what, I’m going to make sure your memory is doing okay.”

In a busy primary care practice, you may actually need to bring the patient back specifically to do that. But that’s usually the approach that I take.

Dr. Christina Chen: You’re right. I feel like that’s such a big gap that’s missing, because the reality is a third of us, if we make it to age 85 will have some form of dementia. The dementia screening is just hard to do. It’s time consuming. What’s the treatment, what’s the course?

I just feel like we need to flip the script there to understand that even early detection and prevention of cognitive impairment pays dividends later on. There’s a long term benefit where our goal is to keep them functional, keep them from falling, keep them from having dementia-related behavior issues that will end up in a bad outcome.

Do you feel like it’s important to also weave in that functional assessment too? Because you mentioned the fall aspect. How do you assess one’s function and their ability to stay independent?

Dr. Daniel Sanchez Pellecer: Basically, at least once a year, all my patients 65 and older, I like to do a balance test in the office. Depending on the results, that can help you counsel patients on whether they need a gait aid, for example, a walker, or a cane. It will definitely help you prevent falls.

The other big thing that I tend to do is measure the gait speed of patients. That’s very highly predictive of disability. If they’re both bad, then I know that I need to worry and concentrate on perhaps doing some balance training, physical therapy, giving patients a gait aid and that sometimes is challenging too. Because many of our older patients don’t want to be on a gait aid.

But, doing the testing in the clinic also helps a lot to show them, “This is why I’m worried.” This is what puts you at risk of future injuries, and I definitely don’t want to deal with a hip fracture. I’m sure you don’t want to deal with that yourself.

Those are the two main things that I focus on when I worry about mobility or function.

Dr. Christina Chen: I feel like prevention really should be a day-to-day thing.

Dr. Daniel Sanchez Pellecer: Right.

Dr. Christina Chen: It shouldn’t be like, “Oh, prevention only happens when I see my doctor once every year, or every other year.” What are day-to-day health maintenance habits that older adults should be adopting as soon as possible?

Dr. Daniel Sanchez Pellecer: Those are particular to older adults, and for all of us. It’s the common sense things like eating well, eating a healthy, balanced diet, exercising ideally every day. I always tell my older patients, “You don’t have to train for a marathon. Movement is life.” It’s definitely exercise. Another big one that we rarely discuss is sleep habits. I always recommend to patients, “You need to be able to sleep enough time.”

I always say “enough time,” because sleeping eight hours does not necessarily apply to every older adult. But sleep enough to the point that you are rested, and trying to reduce stress. Eating, exercise, resting and sleeping well. Those are probably the main things.

Dr. Christina Chen: Yeah, I feel like that’s been a common theme that we’ve heard from all of our speakers on the podcast, is just the importance of all those healthy pillars to well being.

Dr. Daniel Sanchez Pellecer: The other thing that I commonly see and I counsel patients on is, “Let’s try to quit smoking if you are.” Alcohol consumption may be the other one. Try to limit alcohol intake as much as possible. Those are other healthy habits that every older adult should incorporate.

Dr. Christina Chen: Caregivers are unrecognized heroes in so many ways. We want to be able to help support and empower our caregivers who really are doing all the day-to-day. How can we help caregivers stay informed with preventive health practices and help their loved ones stay on task? What are some resources for them?

Dr. Daniel Sanchez Pellecer: The USPSTF guidelines are the easiest to navigate. They’re widely available online. They’re free. It’s very easy to access, and they’re very straightforward and they come with nice graphs and tables. Very easy to understand. That’s probably what I would recommend.

Dr. Christina Chen: What have been your personal observations with health maintenance that has been delivered well and delivered effectively? Do you have any good outcomes or positive stories to share from your practice?

Dr. Daniel Sanchez Pellecer: Absolutely. Most breast cancers that I caught are so small and so early that my female patients don’t even need to get a mastectomy to get it treated. Usually they just get the tumor out, they get radiation, and that’s it. They don’t even need to get chemotherapy and they’re cured.

I have probably a patient every month sharing a similar story related to that. The other thing that I’ve seen is patients that exercise, they do well in general. Rarely need to start an antihypertensive. Rarely have to use cholesterol medicine. Mobility exercise — that’s very important.

My success stories are just basically keeping patients out of the hospital, healthier with a minimum amount of, or no medications at all.

Dr. Christina Chen: You should share a story about your dad.

Dr. Daniel Sanchez Pellecer: Sure. He is almost 80. He looks in excellent shape. A few years back when we were celebrating his birthday, we went out to a lake. He does slalom water skiing — and he’s really good at it, even better than me.

At his age, he’s still able to really ski really well. I always say, “If I managed to get all my patients by age 80 to still do slalom water skiing, then that would be a success.”

Dr. Christina Chen: My last question for you, and this is a tradition we have on our podcast here: We  just want to get to know our expert and to learn a little bit about how you personally age well. What are things that you like to do? What does aging forward mean to you?

Dr. Daniel Sanchez Pellecer: To answer that question, I’m going to tell you what I tell every medical student, fellow or resident that works with me. After they complete their geriatric rotation, I say, “If you learn only two things from this rotation: Start eating well, take care of yourself and save money. Because getting old tends to be expensive.”

Dr. Christina Chen: That’s what you’re doing right now?

Dr. Daniel Sanchez Pellecer: Yes. Trying to eat well, exercise regularly, and I’m starting to save money. Yes.

Dr. Christina Chen: What kind of exercises do you like to do?

Dr. Daniel Sanchez Pellecer: Running. I used to do a lot of karate when I was young. I do some of that on my own, but mostly running. I love running in the cold, so in a way, I feel that I was meant to live in Minnesota.

Dr. Christina Chen: This was a very helpful conversation, Dr. Sanchez. Thank you for summarizing things so well in a situation where there’s just so much information out there, between guideline recommendations and updates.

It’s just helpful to know what’s the most important for each person, the individualized decision making — and how to effectively use diagnostics in a way that really contributes to not just adding more life to years, but years to life.

Dr. Daniel Sanchez Pellecer: Absolutely. My pleasure. Thanks for having me.

Dr. Christina Chen: That’s all for this episode — hopefully you’re feeling a little more informed, inspired, and empowered. If you would like to explore the USPSTF guidelines  Dr. Sanchez and I discuss throughout this episode, you can check out the show notes online.

On the next episode of “Aging Forward,” hospital stays and how to return home safely.

Dr. Allyson Palmer: How long do you think that patients are out of bed when they’re in the hospital? In a typical 24-hour period, it’s less than one hour.