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  » Preventive Medicine  »  Guidelines for preventive medical services
Age of person
19-39 years 40-64 years 65 + years
HISTORY
Every 1 to 3 years: diet, physical activity; tobacco, alcohol, drugs; sexual practices Same as 19-39 years Every year: same as 19-39 years; and also functional status and symptoms of transient ischemia attacks
PHYSICAL EXAMINATION
Every 1 to 3 years: height, weight, blood pressure Every 1 to 3 years: height, weight, blood pressure, breast Every year: as for 40-64 years and also hearing and visual activity
High risk: oral cavity, thyroid, breast, testes, skin High risk: oral cavity, thyroid, skin, carotids High risk: as for 40-64 years (but every year)
LABORATORY
Pap smear (every 1-3 years), total cholesterol Pap smear (every 1-3 years), mammogram (every 1-2 years after age 50), total cholesterol Mammogram (every 1-2 years until age 75), thyroid indices (women), dipstick urinalysis, total cholesterol
High risk: fasting glucose, rubella antibodies, VDRL, urinalysis, Chlamydia testing, gonorrhea culture, HIV testing, hearing, PPD, ECG, mammogram, colonoscopy High risk: fasting glucose, VDRL, urinalysis, Chlamydia testing, gonorrhea culture, HIV testing, hearing, PPD, ECG, fecal occult blood/sigmoidoscopy/colonoscopy, born mineral content High risk: fasting glucose, PPD, ECG, Pap smear (every 1-3 years), fecal occult blood/ sigmoidoscopy/colonoscopy
SPECIAL COUNSELING
Injury prevention, dental health
High risk: hemoglobin testing, skin protection from ultraviolet light
Injury prevention, dental health, skin protection from ultraviolet light, discussion of aspirin therapy in men and estrogen replacement in women As for 40-64 years and also glaucoma testing
IMMUNIZATIONS
Tetanus-diphtheria booster every 10 years As for 19-39 years except not measles-mumps-rubella Tetanus-diphtheria booster (every 10 years) influenza (every year), pneumococcal
High risk: hepatitis B, pneumococcal, influenza (every year), measles-mumps-rubella   High risk: hepatitis B
* Except for the visit itself, the frequency is at discretion unless otherwise specified.
With counseling for any high-risk behaviors.
SOURCE: Adapted from U.S. Preventive Services Task Force (Guide to Clinical Preventive Services, Baltimore, Williams & Wilkins, 1989), whose official report lists full details, including the definition of high-risk situations.

Intrinsic risk factors for falling and possible interventions

  Interventions  
Risk factor Medical Rehabilitative or environmental
Reduced visual acuity, dark adaptation, and perception Refraction; cataract extraction Home safety assessment
Reduced hearing Removal of cerumen; audiologic evaluation Hearing aid if appropriate (with training); reduction in background noise
Vestibular dysfunction Avoidance of drugs affecting the vestibular system; neurologic or ear, nose, and throat evaluation if indicated Habituation exercises
Proprioceptive dysfunction, cervical degenerative disorders, and peripheral neuropathy Screening for vitamin B12 deficiency and cervical spondylosis Balance exercises; appropriate walking aid; correctly sized footwear with firm soles; home safety assessment
Dementia Detection of reversible causes; avoidance of sedative or centrally acting drugs Supervised exercise and ambulation; home safety assessment
Musculoskeletal disorders Appropriate diagnostic evaluation Balance-and-gait training; muscle-strengthening exercises; appropriate walking and aid; home safety assessment
Foot disorders (calluses, bunions, deformities, edema) Shaving of calluses; bunionectonomy; treatment of edema Trimming of nails; appropriate footwear
Postural hypotension Assessment of medications; rehydration; possible alternation in situational factors (e.g., meals, change of position) Dorsiflexion exercises; pressure-graded stockings; elevation of head of bed; use of tilt table if condition is severe
Use of medications (sedatives: benzodiazepines, phenothiazines, antidepressants; antihypertensives; others: antiarrhythmics, anticonvulsants, diuretics, alcohol) Steps to be taken:
1. Attempted reduction in the total number of medications taken
2. Assessment of risks and benefits of each medication
3. Selection of medication, if needed, that is least centrally acting, least associated with postural hypotension, and has shortest action
4. Prescription of lowest effective dose
5. Frequent reassessment of risks and benefits
 
SOURCE: After Tinetti and Speechley.

Environmental factors affecting the risk of falling in the home

Environmental area or factor Objective and recommendations
All areas
Lighting
Absence of glare and shadows; accessible switches at room entrances; night light in bedroom, hall, bathroom
Floors Nonskid backing for throw rugs; carpet edges tacked down; carpets with shallow pile; nonskid wax on floors; cords out of walking path; small objects (e.g. clothes, shoes) off floor
Stairs Lighting sufficient, with switches at top and bottom of stairs; securely fastened bilateral handrails that stand out from wall; top and bottom steps marked with bright, contrasting tape; stair rises of no more than 6 in; steps in good repair; no objects stored on steps
Kitchen Items stored so that reaching up and bending over are not necessary; secure step stool available if climbing is necessary; firm, nonmovable table
Bathroom Grab bars for tub, shower, and toilet; nonskid decals or rubber mat in tube or shower; shower chair with handheld shower; nonskid rugs; raised toilet seat; door locks removed to ensure access in an emergency
Yard and entrances Repair of cracks in pavement, holes in lawn; removal of rocks, tools, and other tripping hazards; well-lit walkways, free of ice and wet leaves; stairs and steps as above
Institutions All the above; bed at proper height (not too high or low); spills on floor cleaned up promptly; appropriate use of walking aids and wheelchairs
Footwear Shoes with firm, nonskid, nonfriction soles; low heels (unless person is accustomed to high heels); avoidance of walking in stocking feet or loose slippers
SOURSE: After Tinetti and Speechley.