This stage involves managing multiple chronic conditions while optimizing quality of life, independence, and functional capacity. Preventive care and health maintenance remain important while balancing treatment burden.
Management of multiple chronic diseases
Fall prevention and safety
Cognitive and mental health
Functional independence
Medication management
Palliative care planning
Annual comprehensive physical exam
Cardiovascular assessment
Diabetes screening and management
Cancer screenings (individualized based on life expectancy and prior screening)
Cognitive screening (Montreal Cognitive Assessment, Mini-Cog)
Mood screening (PHQ-9)
Hearing and vision tests
Bone density assessment
Medication review (deprescribing if appropriate)
Fall risk assessment
Nutritional status assessment
Annual influenza vaccine
Pneumococcal vaccine: PCV20 or PCV15 + PPSV23
Shingles vaccine (Shingrix, if not previously given)
COVID-19 vaccine (annual or as recommended)
Tetanus/diphtheria (Td) booster every 10 years
Tdap (if indicated by exposure risk)
1600–2000 kcal/day (varies by activity level). Higher protein (1.0–1.2 g/kg) to preserve muscle. Calcium 1000–1200 mg, vitamin D 800–1000 IU. Ensure adequate hydration. Address swallowing difficulties and dental issues.
Home safety modifications (remove fall hazards, adequate lighting, grab bars)
Regular physical activity (balance, strength, endurance) to prevent falls
Maintain cognitive engagement (puzzles, reading, social activities)
Regular medication reviews to minimize polypharmacy
Hearing aids and vision correction as needed
Preventive dental care
Social engagement to combat isolation and depression
Advance care planning and end-of-life discussions
Caregiver support if needed