A criterion-based review of preventive health care in the elderly. Part 1. Theoretical framework and development of criteria

Abstract

The magnitude of health care resources devoted to care for the elderly is increasing; however, little is known about the efficacy of the services purchased with those resources. This is especially true in the area of preventive health care. In the absence of a consistent and comprehensive definition of health for the elderly population, it has been difficult either to establish criteria for evaluating preventive services or to assess the impact of those services. This article extends criterion-based review to the assessment of preventive services for the elderly. Health in the elderly can be defined by three related factors: the absence of disease, the maintenance of optimal function, and the presence of an adequate support system. Based on this definition of health, goals for preventive care should include compression of morbidity in addition to prevention of disease, and will require that quality of life be measured to completely assess the value of services. Unfortunately, existing measures of quality of life are difficult to apply to the elderly population, and there are no consistent societal values on which to base a new definition for quality of life. Because existing sets of criteria for the evaluation of preventive services do not address the distinctive health issues affecting the elderly, we have constructed a set of six criteria designed specifically for the well elderly population. In a companion article, we will apply these criteria to candidate preventive services for the elderly population to develop a geriatric health maintenance protocol for use in clinical practice.