Adult Primary Care

Adult Primary Care covers people  18 years and older and there are many conditions that can be prevented, slowed, or managed.  So this list does not include every condition we treat in adult primary care. For more information, please call Molét Health & Wellness, PC 474-227-4113

Health Promotion and Prevention

Lifestyle Measures That Help Prevent Common Chronic Diseases*

Disease prevention is treatment intended to prevent a disease from occurring or worsening. Disease prevention measures benefit independent older people with minimal or no chronic disease and older people with several noncurable but treatable diseases.

Primary and Secondary Prevention

Primary prevention aims to stop disease before it starts, often by reducing or eliminating risk factors. Primary prevention may include immunoprophylaxis (vaccinations), chemoprophylaxis (see table Chemoprevention and Immunization for Older Patients ), and lifestyle changes (see table Lifestyle Measures That Help Prevent Common Chronic Diseases ).

Secondary prevention aims to detect and treat disease or its complications at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality.

Screening can be used to detect risk factors, which may be altered to prevent disease, or to detect disease in asymptomatic people, who can then be treated early.

Multiple organizations publish screening guidelines, which sometimes differ. Whatever a guideline recommends, individual patient characteristics and preferences must also be considered. Guidelines for cancer screening and screening for certain other disorders (eg, abdominal aortic aneurysm, elder abuse, depression) are available.

Tertiary Prevention

In tertiary prevention, an existing symptomatic, usually chronic disease is appropriately managed to prevent further functional loss. Disease management is enhanced by using disease-specific practice guidelines and protocols. Several disease management programs have been developed:

Disease-specific care management: A specially trained nurse, working with a primary care physician or geriatrician, coordinates protocol-driven care, arranges support services, and teaches patients.

Chronic care clinics: Patients with the same chronic disease are taught in groups and are visited by a health care professional; this approach can help patients with diabetes achieve better glucose control.

Specialists: Patients with a chronic disease that is difficult to stabilize can be referred to a specialist. This approach works best when the specialist and primary care physician work collaboratively.

Patients with the following chronic disorders, which are common among older adults, can potentially benefit from tertiary prevention.

Arthritis (primarily osteoarthritis; much less commonly, rheumatoid arthritis) affects about half of people ≥ 65. It leads to impaired mobility and increases risk of osteoporosis aerobic and muscular deconditioning, falls, and pressure ulcers.

Tests to measure bone density can detect osteoporosis before it leads to a fracture. A healthy diet, calcium and possibly vitamin Dsupplementation, exercise, and cessation of cigarette smoking can help prevent osteoporosis from progressing, and treatment can prevent new fractures.

Hyperglycemia, especially when the glycosylated hemoglobin (HbA1C) concentration is > 7.9% for at least 7 years, increases the risk of retinopathy, neuropathy, nephropathy, and coronary artery disease. Glycemic treatment goals should be adjusted based on patient preferences, duration of diabetes, comorbid conditions, vascular complications, risks related to hypoglycemia, concomitant medications, and life expectancy. For most adults ,an HbA1C goal of < 7% without significant hypoglycemia is appropriate. However, appropriate HbA1C goals can change based on additional factors:

< 7.5% for otherwise healthy diabetic older patients with a life expectancy of > 10 years

< 8.0% for patients with comorbidities and a life expectancy of < 10 years

< 9.0% for frail patients with a limited life expectancy

Control of hypertension and dyslipidemia in diabetic patients is particularly important.

Patient education and foot examinations at each visit can help prevent foot ulcers.

Older patients with a history of coronary artery disease, cerebrovascular disease, or peripheral vascular disease are at high risk of disabling events. Risk can be reduced by aggressive management of vascular risk factors (eg, hypertension, smoking, diabetes, obesity, atrial fibrillation, dyslipidemia).

Morbidity due to heart failure is significant among older adults, and the mortality rate is higher than that of many cancers. Appropriate, aggressive treatment, especially of systolic dysfunction, reduces functional decline, hospitalization, and mortality rate.

Smoking cessation, appropriate use of inhalers and other medications, and patient education regarding energy-conserving behavioral techniques can decrease the number and severity of exacerbations of COPD leading to hospitalization.