Quality Indicators for Screening and Prevention in Vulnerable Elders

Screening and prevention in vulnerable elders (VEs) focuses on evidence-based interventions that minimize functional limitations and increase the number of healthy years lived. Primary prevention is directed at disease avoidance and includes immunizations, lifestyle modifications (e.g., tobacco and alcohol use), and chemoprophylaxis. Secondary prevention focuses on early detection and treatment of asymptomatic disease (e.g., screening for hearing or vision impairment). Tertiary prevention intervenes to prevent functional decline from progression of established illness. Targeted comprehensive geriatric assessment (CGA) is an example of primary, secondary, and tertiary prevention. This article presents proposed quality indicators (QIs) for primary, secondary, and tertiary preventive interventions in the vulnerable older population and review the data supporting each indicator. METHODS: A total of 428 articles were considered in this review: 107 identified through a Web search, 73 through reference mining, 75 through Assessing Care of Vulnerable Elders (ACOVE)-1 reference mining, and 161 through the ACOVE-3 literature searches. Twelve additional articles were included after peer review. RESULTS: Of the 20 potential QIs, the expert panel process judged 17 to be valid; three were rejected. One indicator focused on cardiovascular risk was moved to Ischemic Heart Disease, and one focused on obesity was added from Osteoarthritis. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.