Health promotion and disease prevention in the care of older adults: preventive practice in primary care.

Prevention is an important and appropriate component of the primary care of older adults. Office-based approaches to prevention include routinely scheduled examinations for health maintenance and case finding for early disease and disability during visits scheduled for other purposes. The primary care clinician is the optimal person for effective preventive intervention in patients 65 years and older. The spectrum of preventive activities ranges from screening by history taking, physical examination, and laboratory tests to intervention by counseling and therapeutic intervention. Unfortunately, substantial barriers exist to widespread incorporation of preventive practices into primary care, including the need for information and the low level of third-party reimbursement in this area.