Health Promotion for Older Adults: A Framework for Personalized Health Advice During Medicare Wellness Visits

As the population ages, growing evidence supports health promotion strategies to optimize functional status and reduce morbidity and mortality in older adults. Medicare Wellness Visits provide a unique opportunity to deliver preventive care services to this population on an annual basis. Key required elements of Medicare Wellness Visits include providing personalized health advice accompanied by appropriate referrals and a list of risk factors and conditions for which primary, secondary, and tertiary prevention interventions are recommended. Currently no standardized materials exist to achieve these aims. Inspired by the American Academy of Pediatrics model of anticipatory guidance in pediatric wellness visits, the purpose of this project is to develop an evidence-based framework for providers addressing personalized health advice for older adults. Specifically, four major topics required by Medicare Wellness Visits are addressed: cognitive impairment, depression, functional ability, and falls. In addition, general health promotion topics that may benefit all patients regardless of risk assessment are outlined. Incorporating personalized health advice into each Medicare Wellness Visit, along with U.S. Preventive Services Task Force recommended screenings, can serve as a basis for shared goal-setting and referral to multidisciplinary and community-based resources to promote healthy aging. The framework was evaluated based on user reviews elicited by a questionnaire distributed via professional listserv and local providers. Local implementation took place via integration of the framework into an electronic medical record at Oregon Health and Science University. Dissemination included preparation of an abstract for submission to a professional conference for a poster presentation as well as a manuscript for submission to a peer-reviewed journal.