MORBIDITY AS A FOCUS OF PREVENTIVE HEALTH-CARE IN THE ELDERLY
MORBIDITY AS A FOCUS OF PREVENTIVE HEALTH-CARE IN THE ELDERLY
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DOI：
10.1093/oxfordjournals.epirev.a036028
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发表时间：
1988-01-01
影响因子：
5.5
通讯作者：
BUSH, TL
中科院分区：
文献类型：
--
作者：
FRIED, LP;BUSH, TL
老年人的预防保健问题范围很广，从偶发疾病到流行疾病，再到疾病的影响（后遗症）。老年人疾病负担的一个主要组成部分来自流行的慢性病。为了对这一负担产生重大影响，需要明确制定和测试针对老年人的独特预防性保健战略。这些战略必须将预防残疾和维持功能作为一项目标。目前对老年人定期健康检查和预防性保健的建议只包括老年预防性保健方法的最低限度的组成部分。一项全面的老年人战略的具体内容和影响尚待确定。全面的老年定期健康检查最终将基于对上述风险因素、修饰因子、偶发和流行疾病相关问题的流行病学定义，并结合对以下内容的更好理解：1）老年人疾病的动力学或模型，2）有意义和重要的结果，3）干预最有效的时间点，（4）进一步界定造成老年人口疾病负担的主要问题。以流行病为重点的预防目标将包括减缓老年人发病率的上升、残疾的发展以及叠加急性疾病和伤害的发生率，并最大限度地提高老年人的功能自主性和生活质量。为了实现这些目标，流行病学在理解老龄人口的疾病负担方面做出了重大贡献，包括：1）确定老年人疾病和相关残疾的风险因素和影响因素，以及老年人疾病和相关残疾的自然史，2）确定对老年人有意义的结果，这些结果反映了疾病负担，以及3）确定关键点，在这些关键点之前，干预措施对预防残疾是有效的。
The broad spectrum of preventive health concerns in the elderly ranges from incident disease to prevalent disease to the effect (sequelae) of disease. A major component of the burden of illness for the elderly derives from prevalent chronic disease. For a substantial impact on this burden, unique preventive health care strategies specific to the elderly need to be clearly formulated and tested. These strategies must include as a goal the prevention of disability and the maintenance of functioning. Current recommendations for periodic health examinations and for preventive health care for the elderly include only minimal components for a geriatric preventive health care approach. The specific content and impact of a full geriatric strategy is yet to be defined. A comprehensive geriatric periodic health examination will ultimately be based on epidemiologic definitions of the issues regarding risk factors, modifiers, and incident and prevalent disease as described above, melded with improved understanding of 1) the dynamics or models of illness in the elderly, 2) meaningful and important outcomes, 3) the points before which intervention will be most effective, and 4) further definition of the problems that contribute most to the burden of illness across the elderly population. The goals of prevention focused on prevalent disease will include attenuating the progression of morbidity, the development of disability, and the incidence of superimposed acute illness and injuries, and maximizing functional autonomy and quality of life in older persons. To accomplish these goals, epidemiology has major contributions to make in understanding the illness burden of an aging population, including 1) defining risk factors and effect modifiers for, and natural history of, disease and associated disability in older persons, 2) defining outcomes meaningful to older persons which express the burden of illness, and 3) identifying critical points before which intervention is efficacious in preventing disability.