What is preventive care? Screenings, check-ups, patient counseling, and detection of illness at an early stage when treatment is likely to work best. Getting recommended preventive services and making healthy lifestyle choices are key steps to good health
The harms and benefits of screening for individuals age 76 with no comorbid conditions were equivalent to those age 74 with mild comorbidity, age 72 with moderate comorbidity, and age 66 with severe comorbidity.
Prostate Cancer Screening
Individual risks and benefits of screening. Men between the ages of 55 to 69 years are most likely to benefit from screening (PSA), Black men and men with a positive family history of prostate cancer have a higher lifetime risk
Colorectal Cancer Screening
Colonoscopy is the invasive screening procedure of choice, initiated at age 50
Colonoscopy every 10 years, flexible sigmoidoscopy every five years with or without annual stool immunochemical testing, stool testing for blood (high sensitivity guaiac or immunochemical) annually.
2016 recommendations from the USPSTF suggest offering CRC screening to average-risk individuals aged 50 to 75. The USPSTF recommends against screening for adults older than age 85 years and against routine screening for adults 76 to 85 years of age, though specific considerations may support CRC screening
Patients with a history of polyps/CRC repeat every 3 years until normal then repeat every 5 years
Family history of CRC or polyps in first-degree relatives start colonoscopy at age 40 or 10 years before diagnosis of youngest case in family, if normal then repeat in 3-5 years
FAP cases start colonoscopy at puberty and continue every 1-2 years
Patients with UC should have a colonoscopy 8 year after disease onset, and then every year thereafter
Breast Cancer Screening
For women at average risk who undergo mammography, screening biennially from 50-74 will detect nearly as many cancers as annual screening and reduces the risk of false-positive readings
The American Geriatrics Society has identified breast cancer screening as one of its targets for the “Choosing Wisely” campaign and recommends that breast cancer screening should not be undertaken in women with a life expectancy less than 10 year
Screening in women with shorter life expectancy would expose them to potential immediate harm with little chance of benefit
DXA Scan is used to measure bone mineral density and is a diagnostic tool for osteoporosis and osteopenia
T-score compares the patient’s BMD to that of a young healthy adult of the same sex
T-score of greater than -2.5 indicated osteoporosis
The USPSTF also recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures, including those with low body weight.
In women and men with low bone mass (T-score -2.00 to -2.49) at any site or who have risk factors for ongoing bone loss (glucocorticoid use, hyperparathyroidism), follow-up DXA scan approximately every two years, if the risk factor persists
In women 65 years of age and older with a T-score -1.50 to -1.99 at any site, and with no risk factors for accelerated bone loss, follow-up DXA in three to five years
In women 65 years of age and older with T-score -1.01 to -1.49 and no risk factors for accelerated bone loss, follow-up DXA in 10 to 15 years
Falls and Mobility
Approximately 30 percent of noninstitutionalized older adults fall each year. Five percent of falls in older adults result in fracture or hospitalizations. Always ask about any recent falls
“Get Up and Go” test: Pt arises from a sitting position, walks 10 feet, turn, and returns to the chair to sit. If it takes more than 16 seconds to complete the process, or observation of postural instability or gait impairment, this suggests an increased risk of falling, prevent by exercise targeting gait and balance, strength, flexibility, movement (such as tai chi or dance), general physical activity, and endurance
Vitamin D supplementation.