Prévention des décompensations dans les situations à risque Prevention of Decompensation in Critical Situations

In elderly people, the prevention of situations at risk of decompensation should be included in geriatric comprehensive assessment as well as frailty assessment. Similarly, prevention has to be considered in the wider frame of gerontological policies. We distinguish the prevention of affections that, in an isolated way, can lead to an acute decompensation in the elderly person. In this context, prevention includes quitting smoking and drinking, treatment of cardiovascular risk factors (arterial hypertension, hypercholesterolemia), treatment of diabetes, and prevention of fracture risk factors. Too often, elderly people have polypharmacy with higher risk for iatrogenic diseases. The quality of prescription drugs and the improvement of treatment adherence are essential in preventing the iatrogenic risk. In frail, older people, the frailty is a situation of high risk so prevention will include cognitive stimulation, adaptation of physical activity, balanced protein/energy provision, correction of sensory deficiencies, and prevention of psychosocial risks. A multidomain approach is appropriate for this goal. Prevention policies including social prevention are essential.