Goldberg T H, Chavin S I
Division of Geriatric Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
J Am Geriatr Soc. 1997 Mar;45(3):344-54. doi: 10.1111/j.1532-5415.1997.tb00952.x.
To review important current issues, studies, recommendations and controversies relating to preventive medicine and screening in older people. STUDY SELECTION/DATA ABSTRACTION: MEDLINE searches for literature on prevention and screening with regard to older adults as well as each individual condition reviewed; bibliographical reviews of textbooks, journal articles, government and advocacy organization task force reports, and recommendations. Important information synthesized and discussed qualitatively.
Data and recommendations are presented for most common preventive services, including primary prevention and screening for cardiovascular diseases and risk factors, common malignancies, endocrine and infectious diseases, osteoporosis, sensory deficits, and dementia.
The goal of preventive medicine in older people should be not only reduction of premature morbidity and mortality but preservation of function and quality of life. Attempts to prevent diseases of old age should start in youth; the older the patient, the less likely the possibility or value of primary and secondary prevention, and the greater the stress must be on tertiary prevention. Age 85 is proposed as a general cutoff range beyond which conventional screening tests are unlikely to be of continued benefit; however, care must always be individualized. Emphasis should be on offering the best proven and most effective interventions to the individuals at highest risk of important problems such as cardiovascular diseases, malignancies, infectious and endocrine diseases, and other important threats to function in older people. Breast cancer screening, smoking cessation, hypertension treatment, and vaccination for infectious diseases are thus far among the most firmly proven and well accepted specific preventive measures, with physical exercise also being particularly promising. Although more research is needed, a current working approach is necessary and possible. A summary table of recommendations and information tools such as reminders or flowsheets may be valuable in helping the physician carry out prevention and screening programs.
回顾与老年人预防医学和筛查相关的当前重要问题、研究、建议及争议。研究选择/数据提取：通过医学文献数据库（MEDLINE）检索有关老年人预防和筛查以及所综述的每种个体疾病的文献；对教科书、期刊文章、政府及倡导组织特别工作组报告及建议进行文献综述。对重要信息进行定性综合和讨论。
呈现了针对最常见预防服务的数据和建议，包括心血管疾病及危险因素、常见恶性肿瘤、内分泌和传染病、骨质疏松症、感官缺陷及痴呆症的一级预防和筛查。
老年人预防医学的目标不仅应是降低过早发病和死亡率，还应是保持功能和生活质量。预防老年疾病的尝试应始于青年时期；患者年龄越大，一级和二级预防的可能性或价值越小，三级预防的压力则越大。建议将85岁作为一个大致的界限范围，超过此范围常规筛查测试不太可能继续带来益处；然而，护理必须始终个体化。应重点为面临心血管疾病、恶性肿瘤、传染病和内分泌疾病等重要问题以及老年人其他重要功能威胁的高风险个体提供经充分验证且最有效的干预措施。乳腺癌筛查、戒烟、高血压治疗及传染病疫苗接种是目前最经充分验证且广泛接受的特定预防措施，体育锻炼也特别有前景。尽管还需要更多研究，但当前的工作方法是必要且可行的。建议汇总表及提醒或流程图等信息工具可能有助于医生实施预防和筛查项目。
