preventive healthcare for older adults n.
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Preventive Healthcare for Older Adults. Framing the Issue. USPSTF charge. Conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications)

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uspstf charge
USPSTF charge
  • Conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications)
  • Develops recommendations for primary care clinicians and health systems.
  • Usual Model: Folic Acid Supplementation in Pregnancy
    • Single population
      • Women of Childbearing Age
    • Single intervention
      • Folic Acid supplementation
    • Single outcome
      • Neural Tube Defects
challenges in applying model to the very old
Challenges in Applying Model to the Very Old
  • Many geriatric disorders have multiple risk factors, interventions, and expected outcomes;
  • Older adults are not often represented in clinical trials and are more heterogenous than younger adults; and
  • Important outcomes may not be measured and reported in ways conducive to evidence synthesis and interpretation.
falls analytic framework


(alone or in combination)

Multifactorial Assessment and Management

Risk Evaluation of ages 65+ years

Fall-related fractures and serious injuries;

Quality of Life;



Single clinical treatment

(with or without screening)






Clinical Education/

Behavioral Counseling


Home Hazard



Adverse effects of interventions


Physical Therapy

Other positive outcomes of interventions

Falls Analytic Framework


challenges nontraditional outcomes
Challenges: Nontraditional Outcomes
  • Years of Life gained may not be as important as
    • Independent life or maintenance of function
    • Quality of life, etc
  • Caregiver outcomes
    • Ability to plan by knowing that a patient is dementing
  • Timing of outcomes
    • For syndromes, often can’t reverse the underlying progression of disease (frailty, dementia) but can improve for a period of time
      • How short a period of time is clinically significant
      • Can outcomes be measured too far out and miss significant short term gains?
        • Eg, Hospitalizations at 24 months after a fall intervention?
  • When to stop screening?
payment challenge uncovered preventive services
Payment Challenge: Uncovered Preventive Services
  • Medicare will now pay for USPSTF Grade A and B recommendations (MIPPA)
  • BUT many preventive services have strong evidence showing their benefit, but are not paid for by Medicare
    • are unlikely to be able to meet the stringent criteria for USPSTF recommendation- that SCREENING will improve outcomes more than waiting for the disorder to be manifest
      • Glasses
      • Hearing Aids
      • Dentures
    • What needs to be done to obtain coverage for these preventive services?
Elizabeth Eckstrom: Synthesizing the Evidence
  • Marcel Salive: Medicare coverage of Preventive Services