Morbidity as a focus of preventive health care in the elderly.

The broad spectrum of preventive health concerns in the elderly ranges from incident disease to prevalent disease to the effect (sequelae) of disease. A major component of the burden of illness for the elderly derives from prevalent chronic disease. For a substantial impact on this burden, unique preventive health care strategies specific to the elderly need to be clearly formulated and tested. These strategies must include as a goal the prevention of disability and the maintenance of functioning. Current recommendations for periodic health examinations and for preventive health care for the elderly include only minimal components for a geriatric preventive health care approach. The specific content and impact of a full geriatric strategy is yet to be defined. A comprehensive geriatric periodic health examination will ultimately be based on epidemiologic definitions of the issues regarding risk factors, modifiers, and incident and prevalent disease as described above, melded with improved understanding of 1) the dynamics or models of illness in the elderly, 2) meaningful and important outcomes, 3) the points before which intervention will be most effective, and 4) further definition of the problems that contribute most to the burden of illness across the elderly population. The goals of prevention focused on prevalent disease will include attenuating the progression of morbidity, the development of disability, and the incidence of superimposed acute illness and injuries, and maximizing functional autonomy and quality of life in older persons. To accomplish these goals, epidemiology has major contributions to make in understanding the illness burden of an aging population, including 1) defining risk factors and effect modifiers for, and natural history of, disease and associated disability in older persons, 2) defining outcomes meaningful to older persons which express the burden of illness, and 3) identifying critical points before which intervention is efficacious in preventing disability.