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Preventive Measures


Annals of Long-Term Care: Clinical Care and Aging. 2014;22(2):15.


Gregg Warshaw, MD; Medical Editor

Earlier this month, the World Health Organization projected that the global burden of cancer will increase 70% over the next two decades, with an estimated 22 million new cases and 13 million deaths anticipated each year by 2032. These are certainly sobering statistics, and cancer is not the only life-threatening disease on the rise. Many other diseases, including dementia, heart disease, and diabetes, are projected to become more prevalent in the coming decades, making preventive measures all the more critical.

Geriatric care providers, especially in long-term care (LTC) settings, focus more on managing existing diseases than on preventing them, whether out of necessity or because patients simply do not present until there is a problem. In geriatrics, there is considerable disease burden to contend with, as older age increases the risk of many diseases and conditions. Nevertheless, while many diseases encountered in older patients require prompt and ongoing treatment, there are still preventive measures that can be used to optimize the overall health of these patients, even when their disease burden has increased to the point that LTC services are required. This issue of Annals of Long-Term Care: Clinical Care and Aging® explores some preventive measures that should be considered.

In our first article, “Underrecognition of Osteoporosis in Men in the Long-Term Care Setting”, the authors examine osteoporosis, which is more often thought to be a women’s disease, reducing the likelihood of preventive measures being considered for male patients. However, the National Osteoporosis Foundation estimates that one in four men aged 50 years and older will experience a fracture as a result of osteoporosis, placing this population at greater risk of fracture than of developing prostate cancer. To address this misconception and underrecognition of osteoporosis in men, the American College of Physicians issued guidelines in 2008 to help diagnose osteoporosis in this population. To see if physicians adhered to these guidelines, the authors conducted a chart review that assessed differences in osteoporosis screening and interventions between male and female patients presenting to an LTC facility for subacute rehabilitation following a low-trauma hip fracture. They found that osteoporosis was underrecognized and undertreated in men at this facility. For example, only 5% of male patients were given vitamin D and calcium supplements, compared with 28.3% of women. Based on their findings, which mimic those in other reports in the literature, the authors conclude that more must be done to address osteoporosis among male patients.

In our second article, “Role of Nutrition in the Prevention of Cognitive Decline”, the authors review the evidence for the role of nutrition in the clinical management of dementia and related symptoms. They note that certain nutrients in foods are easily accessible and may help protect brain health, and they specifically examine the literature with regard to various antioxidants, including vitamin C and E, B-complex vitamins, carotenoids, and polyphenols. They also examine whether any benefits have been observed with calorie restriction. Although the literature has shown mixed results, malnutrition may advance the progression of cognitive dysfunction and contribute to a variety of other health problems, making overall nutrition an important preventive measure for all LTC residents.

In this issue, you will also find a Medicare Update that announces a proposed rule change by the Centers for Medicare & Medicaid Services (CMS) that may affect older adults on Part D by limiting their access to antipsychotics and antidepressants. CMS is accepting comments on this proposal until March 7, 2014. If you would like to comment, you can take a three-question survey on our website or send comments to our associate editor, Allison Musante, at We will send all results and comments to CMS by the deadline.

We hope you find the articles in this month’s issue useful. If you are interested in submitting an article to us for consideration, please see our author guidelines.

Thank you for reading!

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