# Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association. The nurse lists the activities of the older persons' program. Which activity is SECONDARY prevention?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association.

The nurse lists the activities of the older persons' program. Which activity is SECONDARY prevention?

## 보기

1. Weekly group strength-and-balance exercise sessions
2. Yearly influenza vaccination of the senior citizens
3. Home exercises and a walker after a hip fracture
4. Screening for depression, vision, and hearing loss **✔ 정답**

**정답: 4**

## 해설

Secondary prevention detects disease or problems early so they can be treated promptly; screening for depression, vision, and hearing loss fits this level. Exercise programs and vaccination prevent problems from occurring (primary prevention). Rehabilitation with exercises and assistive devices after a fracture limits disability (tertiary prevention).

## 심화 해설

Levels of Prevention in the Older Persons Program

The question asks you to classify a program activity according to the three levels of prevention. The correct answer is screening for depression, vision, and hearing loss, which is secondary prevention because its purpose is early detection of already-existing but unrecognized problems.

Why Screening Is Secondary Prevention

Secondary prevention does not stop a disease from starting. Instead, it identifies disease or functional decline at an early, often asymptomatic stage so that treatment can begin sooner and outcomes can improve. In the older persons program, screening for depression, vision deficits, and hearing loss fits this definition precisely. These conditions are common in older adults, frequently go unnoticed, and are treatable when detected early.

The rationale is supported by the broader screening literature. A randomized clinical trial of home-based screening for atrial fibrillation in adults aged 75 years or older demonstrated that screening asymptomatic individuals can lead to interventions—such as anticoagulation—that prevent downstream events like stroke [2]. The principle is the same: the disease is already present, but the person does not know it, and the screening test is the first step in identifying it.

However, screening in older adults is not automatically beneficial in every case. One review cautions that frail older persons may have less physiological reserve, greater comorbidity, and shorter life expectancy, which can shift the balance away from aggressive follow-up after a positive screen [4]. This does not mean screening is wrong; it means the nurse must select screening targets—like depression, vision, and hearing—where early detection leads to practical, low-burden interventions that improve quality of life.

Differentiating the Three Levels

The other options represent primary and tertiary prevention, and the distinction is a high-yield exam point.

| Level | Goal | Example from the options | Key feature |
| --- | --- | --- | --- |
| Primary prevention | Prevent disease or injury before it occurs | Weekly strength-and-balance exercise sessions; yearly influenza vaccination | Targets healthy or at-risk persons to reduce future incidence |
| Secondary prevention | Detect existing disease early, before symptoms or complications | Screening for depression, vision, and hearing loss | Disease is already present but unrecognized |
| Tertiary prevention | Limit disability and improve function after disease or injury | Home exercises and a walker after a hip fracture | Rehabilitation and assistive devices after the event |

Watch out! The exercise program in option 1 is primary prevention because it aims to prevent falls and fractures before they happen. But exercise prescribed *after* a hip fracture—as in option 3—is tertiary prevention because the injury has already occurred and the goal is rehabilitation.

Key point! The timing of the condition relative to the intervention determines the level. If the condition does not yet exist and the goal is to keep it from occurring, it is primary. If the condition exists but is undetected, it is secondary. If the condition has already caused damage and the goal is to restore function or prevent further decline, it is tertiary.

Clinical Application in the Farming Barangay

In a rural, farming community, older persons may have limited access to specialty care, so community-based screening by the public health nurse and BHWs is especially valuable. Vision and hearing screening can identify correctable deficits that contribute to social isolation, falls, and cognitive decline. Depression screening is critical because late-life depression is underrecognized and treatable. The nurse’s role is not only to administer the screening tools but also to ensure that positive results are linked to follow-up care—otherwise screening has no benefit.

The fall-risk screening guideline referenced in one study recommends annual fall risk screening for all adults aged 60 years and older . This reinforces that screening is a standard secondary prevention activity in older adult health programs. At the same time, the nurse should recognize that screening alone does not prevent anything; it is the bridge to early treatment that produces the benefit.References (research sources)

- [2]Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial.RCT/clinical trialGladstone DJ, Wachter R, Schmalstieg-Bahr K, Quinn FR, Hummers E, Ivers N (2021) · DOI: 10.1001/jamacardio.2021.0038

- [4]Screening in frail older people: an ounce of prevention or a pound of trouble?Research articleClarfield AM (2010) · DOI: 10.1111/j.1532-5415.2010.03070.x

## 임상 시나리오

Levels of Prevention in Older Adult ProgramsClassifying Community Health Activities
Secondary prevention focuses on early detection of existing but unrecognized conditions. Screening for depression, vision loss, and hearing loss in older adults identifies problems at an asymptomatic or early stage, allowing prompt treatment and better outcomes.

Primary prevention prevents problems before they start—examples include yearly influenza vaccination and weekly strength-and-balance exercise sessions. Tertiary prevention limits disability after an event has occurred, such as home exercises and a walker after a hip fracture.

CautionScreening in frail older adults is not automatically beneficial—consider comorbidity, life expectancy, and whether early detection will change management. Always link screening to a clear follow-up plan.

## 핵심 개념

- **Secondary prevention** — Early detection of existing but unrecognized disease or functional decline to enable prompt treatment and improve outcomes.
- **Primary prevention** — Interventions that prevent disease or injury from occurring in the first place, such as vaccination and exercise programs.
- **Tertiary prevention** — Interventions that limit disability and restore function after a disease or injury has already occurred, such as rehabilitation.
- **Screening** — Systematic testing or assessment of asymptomatic individuals to identify disease or risk factors at an early stage.

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