causes of mortality are provided by the Mortality Statistics Branch at the National Center for Health Statistics. Data are from 2004, the most recent year for which final data are available. The causes are ranked. From American College of Obstetricians and Gynecologists, Primary and preventive care: periodic assessments. ACOG Committee Opinion No. 452. Obstet Gynecol 2009;144:1444–1451.
routine primary care for which populations. Primary preventive measures are those that involve intervention before the disease develops, for example, quitting smoking, increasing physical activity, eating a healthy diet, quitting alcohol and other drug use, using seat belts, and receiving immunizations. Secondary preventive measures are those used to identify and treat asymptomatic persons who have risk factors or preclinical disease but in whom the disease itself has not become clinically apparent. Examples of secondary preventive measures are well known in gynecology, such as screening mammography and cervical cytology testing.
Table 8.4 Periodic Assessment Ages 65 and Older
Health status: medical, surgical, family Human immunodeficiency virus (HIV) testing
Use of complementary and alternative medicine Sexuality
Tobacco, alcohol, other drjg use, and concurrent medication use Sexual function
Weight Exercise: discussion of program
Neck: adenopathy, thyroid Neglect/abuse
Breasts, axillae Lifestyle/stress
Bone mineral density screening (In the absence of new risk Dyslipidemia factors, screen no more frequently than every 2 years.)
Cervical cytology: consider discontinuing at age 65 years or Obesity 70 years if patient has had three or more normal results in a row, no abnormal results in 10 years, no history of cervical cancer, no history of diethylstilbestrol exposure in utero, is human immunodeficiency virus (HIV) negative, is not immunosuppressed; if cervical cytology has been discontinued, annual review of risk factors to evaluate need for reinitiation of screening. If cervical cytology is needed: may screen every 3 years after three consecutive negative test results if no history of cervical intraepithelial neoplasia 2 or 3, immunosuppression, HIV infection, or diethylstilbestrol exposure in utero or every 3 years after negative human papillomavirus DNA test and negative cervical cytology.‡
Colorectal cancer screening§: colonoscopy every 10 years Diabetes mellitus (preferred)
Table 8.4 (Continued ) —Exercise and sports involvement Leading Causes of Death∗∗ —Firearms 1. Diseases of the heart —Occupational hazards 2. Malignant neoplasms —Prevention of falls 3. Cerebrovascular diseases —Recreational hazards 4. Chronic lower respiratory diseases —Safety belts and helmets 5. Alzheimer’s disease
Skin exposure to ultraviolet rays 6. Inﬂuenza and pneumonia
Suicide: depressive symptoms 7. Diabetes mellitus
Tobacco, alcohol, other drug use 8. Nephritis, nephrotic syndrome, and nephrosis
Visual acuity/glaucoma 9. Accidents (unintentional injuries)
Immunizations 10. Septicemia
Herpes zoster (single dose, if not previously immunized)
Varicella vaccine (one series for those without evidence of immunity) ∗When a woman’s age or other health issues are such that she would not choose to intervene on conditions detected during the routine examination, it is reasonable to discontinue pelvic exams. †See Table 8.5.