Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb;66(2):229-234.
doi: 10.1111/jgs.15216. Epub 2017 Nov 20.

Individualizing Prevention for Older Adults

Sei J Lee  1   2 , Christine M Kim  3
Affiliations

Individualizing Prevention for Older Adults

Sei J Lee et al. J Am Geriatr Soc. 2018 Feb.

Abstract

Prevention can help older adults avoid illness by identifying and addressing conditions before they cause symptoms, but prevention can also harm older adults if conditions that are unlikely to cause symptoms in the individual's lifetime are identified and treated. To identify older adults who preventive interventions are most likely to benefit (and most likely to harm), we propose a framework that compares an individual's life expectancy (LE) with the time to benefit (TTB) for an intervention. If LE is less than the TTB, the individual is unlikely to benefit but is exposed to the risks of the intervention, and the intervention should generally NOT be recommended. If LE is longer than the TTB, the individual could benefit, and the intervention should generally be recommended. If LE is similar to the TTB, the individual's values and preferences should be the major determinant of the decision. To facilitate the use of this framework in routine clinical care, we explored ways to estimate LE, identified the TTB for common preventive interventions, and developed strategies for communicating with individuals. We have synthesized these strategies and demonstrate how they can be used to individualize prevention for a hypothetical beneficiary in the setting of a Medicare annual wellness visit. Finally, we place prevention in the context of curative and symptom-oriented care and outline how prevention should be focused on healthier older adults, whereas symptom-oriented care should predominate in sicker older adults.

Keywords: cancer screening; life expectancy; prevention; time to benefit.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: SJL and CMK have no conflicts of interests to disclose. Specifically, SJL and CMK have no financial, personal or potential conflicts.

Figures

Figure 1
Figure 1
Upper, Middle and Lower Quartiles of Life Expectancy for Women and Men at Selected Ages From US life table data available at: https://www.ssa.gov/oact/STATS/table4c6.html Adapted from: Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001;285:2750-6.
Figure 2
Figure 2
A: Current Paradigm in Palliative Care B: Incorporating Preventive Care into the Palliative Care Paradigm
See this image and copyright information in PMC

References

    1. Schwartz LM, Woloshin S, Fowler FJ, Jr, Welch HG. Enthusiasm for cancer screening in the United States. JAMA. 2004;291(1):71–78. - PubMed
    1. Quick Reference Information: The ABCs of Providing the Annual Wellness Visit. The Medicare Learning Network. 2012 http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/.... Accessed September 5, 2013.
    1. Lee SJ, Leipzig RM, Walter LC. Incorporating lag time to benefit into prevention decisions for older adults. Jama. 2013;310(24):2609–2610. - PMC - PubMed
    1. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2013;346:e8441. - PMC - PubMed
    1. Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166(6):605–609. - PubMed

Publication types

LinkOut - more resources