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Logo Aging Q3 Screening and Prevention ACOVE 6 Out Patient Prevention strategies can be classified as primary (preventing the onset of disease), secondary (finding disease in early and curable stages), and tertiary (prevention of further morbidity in established disease). Elderly patients continue to benefit from the primary strategies of vaccination and counseling, but benefit from secondary and tertiary modalities depends on life expectancy and patient acceptance. (Covinsky, 2001) PRIMARY PREVENTION Physician reminders and health maintenance systems increase the provision of preventive services. Recommended vaccinations in patient over 65 years of age Vaccine Intervals dT Every 10 years (replace one booster with Tdap if contact with child <12 months) Pneumovax Once after age 65. If < 65 and 5 years have passed – revaccinate once Influenza Yearly during flu season Zoster Once after age 60 www.cdc.gov accessed 8/9/12 Contraindications and Precautions Contraindications • Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, or prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap. Precautions • Moderate or severe acute illness with or without fever • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoidcontaining vaccine • History of Arthus-type hypersensitivity reaction following a previous dose of tetanus and/or diphtheria toxoid-containing vaccine: defer vaccination until at least 10 years have elapsedsince the previous dose For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized. Contraindication • Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component. Precautions • Moderate or severe acute illness with or without fever Contraindication • Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, including egg protein Precautions • Moderate or severe acute illness with or without fever • History of GBS within 6 wks of previous influenza vaccine Contraindication • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised – CD4<200). Precautions • Moderate or severe acute illness with or without fever. • Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; if possible, avoid use of these antiviral drugs for 14 days after vaccination. rev. 8/10/12 Practice Partner Health Maintenance Templates Templates can be customized by adding medications and disease states. You can enter codes for “Done Elsewhere” and “Refused”. ASK YOUR PRECEPTOR TODAY! Exercise Counseling Elderly patients can build muscle mass, increase endurance, prevent falls, reduce depression and increase functional independence through exercise. Most patients should aim for aerobic exercise 5 days a week and resistance training 2-3 days per week – start with walking. Exercise prescriptions improve compliance with recommendations. Assess exercise readiness and give patients a prescription. Exercise Readiness Assessment 1. Does the patient currently exercise? 2. Is the patient healthy enough for independent exercise (no balance problems/unstable coronary symptoms, etc.)? 3. Determine “stage of change” and which action to take 4. Give an exercise prescription and referral form based on the chart. www.exerciseismedicine.org