Prepared by
Gerard Kerins, M.D., F.A.C.P.
(July 1998)

PURPOSE:

To provide guidance in health promotion and disease prevention activities for those who are providing supports and services to people who are aging.

APPLICABILITY:

This advisory applies to all individuals of the department regardless of the facility or region in which they are served.

GENERAL PRINCIPLES and GUIDELINES

The following is a list of health promotion and disease prevention activities which should be incorporated into the general care of older adults including those persons with Down Syndrome who are aging. These principles can be incorporated into specific protocol development, and there are detailed references available for each of these recommendations should they be required as part of further program development.

1. Frailty or the state of reduced physiological reserve has been shown in older adults to increase susceptibility to becoming disabled. A significant cause of frail health is physical inactivity potentiated by episodes of physiological loss due to illness and injury. Based on this, it is recommended that a low level exercise program, even a brief walking program be incorporated into the general care of all older adults.
2. Cognitive decline is not a normal part of aging and although cognitive deficits and dementia are more common with older persons, many of the conditions that cause dementia and loss of cognitive ability can be prevented. We would recommend that any changes in cognitive capability and related functional decline be fully evaluated not only for reversible causes but also to explore modalities to slow decline should no reversible cause be found.
3. Cancer screening should be an integral part of all health programs of older adults including those with Down Syndrome. Routine cancer screening should include:
   1. Colonoscopy once every 5 years after the age of 50
   2. Yearly fecal occult blood testing
   3. Women:
      1. Yearly breast examination
      2. Annual Mammography
      3. Full GYN exam and Pap smears as indicated
   4. Men:
      1. Yearly prostate examination
      2. Evaluation of prostatic specific antigen
4. Smoking cessation activity should be incorporated into the general health maintenance program of all older adults including if relevant, those with Down Syndrome.
5. Coronary artery disease is the leading cause of death in both older men and women and elevated cholesterol, especially low-density lipoprotein high-density lipoprotein ratios may be a significant risk factor although less so than in middle-aged persons. Based on prior health and family history, it is recommended that the evaluation of such abnormalities be completed in older adults with modification.
6. High blood pressure should be screened for and aggressively treated in older adults at any age. Multiple studies have shown that either isolated systolic or combined hypertension does increase the risks of heart disease and cerebrovascular events.. Based on this, it is recommended that routine blood pressure screening be completed and should elevations be found, appropriate treatments including lifestyle and diet changes, pharmocological regimen, and exercise be incorporated into routine health care.
7. In most persons, the use of low-dose prophylactic aspirin may reduce the risk of heart disease and stroke, and based on an individual basis, this should be assessed in all older adults.
8. Alcohol consumption should be modified, and attempts should be made to taper and discontinue in a medically supervised fashion, in those adults for whom alcohol use may be problematic.
9. Medication should be continuously and intermittently monitored, no only in terms of appropriateness, but related to dosage, realizing that in older adults most medications need to be prescribed in a lower dose.
10. One should include routine screening for depression in the care of older adults including those with Down Syndrome.
11. Routine screens of hearing and vision should be incorporated on a yearly basis as any sensory deprivation has been shown in older adults to predispose their increasing disability and decreased functioning.
12. General dental and podiatry care should be incorporated as part of routine health maintenance.
13. Recommendations should be followed concerning the use of influenza and pneumococcal vaccines in all older adults.

The above are some brief broad guidelines to be incorporated into the routine care of older adults. As stated, they can be further elaborated to specific protocols which should be individualized as needed.