Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 253

Recommendations about areas of lifestyle education in general apply mainly to the Robust and Frail elderly, with a lower level of recommendation for the Moderately Demented elderly. Activity level should be queried because a low level of activity is a significant predictor of mortality among older adults.¹⁴ In Robust elderly, physical activity plays an important role in preventing and reducing mortality and treatment of various chronic and disabling conditions (e.g. obesity, cardiovascular disease, stroke, diabetes mellitus type 2, hypertension, depression, osteoporosis, osteoarthritis, cognitive decline). Frail elderly undergoing randomized trials of exercise experienced fewer falls and injuries and less healthcare utilization. Although the USPSTF does not recommend behavioural counselling of elderly patients by primary care physicians to promote increased physical activity, other professional organizations, such as the American College of Physicians (ACP), American Heart Association (AHA), and American College of Sports Medicine (ACSM) support exercise promotion in the elderly. Specific recommended exercises fall into four categories: aerobic, muscle strengthening, flexibility activities, and balance training.

Physicians should ask patients about smoking and should clearly and directly advise all smokers to quit. Patients who want to quit should be assisted with self‐help materials, encouraged to set a quit date, referred for behavioural therapy, or advised to try OTC or prescription medications.

Alcohol abuse can initially be screened for by asking what quantity a patient consumes regularly. Men who consume more than four drinks per day and women who consume more than two drinks per day are at risk of alcohol‐related problems.¹⁵ A more thorough assessment should include screening tools such as the CAGE questionnaire, MAST, or AUDIT. Of these three, the CAGE questionnaire has the best sensitivity and specificity for diagnosing alcohol dependence.¹⁶ Both the USPSTF and the American Geriatrics Society (AGS) recommend that primary care providers screen their older patients for alcohol misuse.

Areas of education for injury prevention include the use of car seat belts, alcohol‐related risks in relation to driving, home environmental hazards to reduce falls, and the restriction of access to firearms and driving with depressed and cognitively impaired patients.¹⁶