08 Adult Preventive Care and Health Education

Purpose and principles

Preventive care aims to identify risks early, prevent disease, and support function and well-being throughout adulthood. Recommendations depend on age, anatomy, medical and family history, prior screening, exposures, preferences, and the person’s ability to benefit; preventive care is not a fixed checklist.

Screening is intended for people without symptoms. Symptoms or a known condition call for diagnostic evaluation and appropriate treatment pathways instead of relying on screening schedules.

Planning a preventive visit

At a preventive visit, review chronic conditions, medications, family history, tobacco and other substance use, sexual health, and previous screening or vaccination. Consider measurements and screening needs, such as blood pressure, weight-related health risks, and tests appropriate to age or risk.

Agree on realistic prevention goals involving activity, nutrition, sleep, tobacco cessation, or other priorities. Make a follow-up plan for reviewing results, completing referrals or vaccinations, and revisiting goals.

Screening can have benefits and harms, including false-positive results, unnecessary follow-up, and overdiagnosis. Explain what a test can and cannot show, and ensure there is a pathway to evaluate abnormal results. A preventive visit does not mean ordering every available test.

Screening by age and risk

The following examples reflect U.S. Preventive Services Task Force guidance for asymptomatic adults; they are not a complete checklist. Recommendations can change, and people at higher risk may need a different approach.

• High blood pressure: Screen adults aged $18$ and older. Confirm an elevated office reading with measurements outside the clinical setting, such as home or ambulatory monitoring, before diagnosing hypertension or starting treatment. Screening is generally annual from age $40$ and for people at increased risk; lower-risk adults with normal readings may be screened less often.

• Prediabetes and type $2$ diabetes: Screen adults aged $35$–$70$ who have overweight or obesity. Offer or refer people with prediabetes to effective preventive interventions.

• Colorectal cancer: Screen average-risk adults aged $45$–$75$. Options include stool-based tests at recommended intervals and direct visualization tests; an abnormal stool test requires follow-up evaluation. For ages $76$–$85$, decide selectively based on health, previous screening, and preferences.

• Breast cancer: USPSTF recommends mammography every $2$ years for women aged $40$–$74$ at average risk. Evidence is insufficient to determine the balance of benefits and harms at age $75$ or older. Symptoms or substantially increased risk may call for an individualized plan.

• Cervical cancer: Screening applies to people with a cervix and depends on age, prior results, and risk. Do not assume screening is needed after removal of the cervix; a history of cervical precancer or cancer can change the plan. Follow current national guidance because recommendations are being updated.

• Lung cancer: Offer annual low-dose CT to eligible adults aged $50$–$80$ with at least a $20$-pack-year smoking history who currently smoke or quit within the past $15$ years. Stop when $15$ years have passed since quitting, or when health limits life expectancy or the ability to undergo curative surgery. Pair screening with shared decision-making and smoking-cessation support.

• Hepatitis C: Screen adults aged $18$–$79$, including those without recognized risk factors.

• Osteoporosis: Screen women aged $65$ and older, and postmenopausal women younger than $65$ who are at increased risk. Evidence is insufficient to determine the balance of screening benefits and harms in men.

• Abdominal aortic aneurysm: Recommend one-time ultrasound screening for men aged $65$–$75$ who have ever smoked. For men in that age range who have never smoked, consider individual risk and preferences.

• Depression: Screen adults, including older adults and pregnant or postpartum people. A positive result should lead to further assessment and access to evidence-based care.

• Alcohol use: Screen adults for unhealthy alcohol use and offer brief behavioral counseling to people with risky or hazardous use.

Offer other services when indicated by history, exposure, or risk. Review sexual health and infection-testing needs confidentially and without assumptions.

Lifestyle counseling and risk reduction

Counseling is most useful when it is respectful, practical, and connected to a person’s priorities. Ask permission to discuss a health behavior, learn what matters to the person, agree on one achievable next step, and arrange follow-up. Consider barriers such as cost, disability, work schedules, food access, stress, and neighborhood safety.

• Physical activity: Encourage adults to build toward at least $150$ minutes of moderate-intensity activity each week, or an equivalent amount of vigorous activity, and muscle-strengthening activity on at least $2$ days. Any activity is better than none; adapt the plan to health, ability, and safety.

• Nutrition and weight: Encourage a sustainable dietary pattern emphasizing vegetables, fruits, legumes, whole grains, and other nutrient-dense foods while limiting excess sodium, added sugars, and highly processed foods. Discuss weight without stigma. For adults with obesity, offer or refer to intensive, multicomponent behavioral intervention when appropriate.

• Tobacco and nicotine: Ask about use, advise quitting, and offer behavioral support and appropriate cessation medication to nonpregnant adults who smoke. In pregnancy, behavioral counseling is recommended; medication decisions require individualized clinical judgment.

• Alcohol and other substances: Ask in a neutral, nonjudgmental way. Brief counseling can help reduce risky alcohol use; connect people who need more support with appropriate treatment services.

• Cardiometabolic risk: Pair screening with prevention. When elevated blood pressure, abnormal glucose, or other risk factors are identified, discuss the next evaluation and a plan for lifestyle changes or treatment rather than leaving the result unexplained.

Vaccination, mobility, and healthy aging

Vaccination remains part of adult health maintenance. Review the current CDC adult schedule and the person’s age, prior doses, pregnancy status, medical conditions, occupation, and exposures, because recommendations may differ by these factors. Common adult vaccine topics include influenza, COVID-19, tetanus and pertussis, shingles, pneumococcal disease, and other vaccines indicated by age or risk.

With aging, prevention increasingly includes maintaining mobility and independence. Review falls, medications that may impair balance or alertness, vision and hearing concerns, strength and activity, and the person’s living environment. For community-dwelling adults aged $65$ and older who are at increased risk of falls, exercise interventions can help reduce risk.

When deciding whether to continue or stop age-based screening, discuss goals and likely benefit. Health status and previous testing matter, not age alone.