PREVENTIVE MEDICINE AND SCREENING IN OLDER ADULTS:
SUMMARY OF RECOMMENDATIONS

Todd H. Goldberg, M.D.

Division of Geriatric Medicine, West Virginia Health Sciences Center/CAMC, Charleston, WV

Adapted from: Goldberg TH, Chavin SC. Preventive medicine and screening in older adults.
J Am Geriatr Soc 1997;45(3):344-354. Update: J Am Geriatr Soc 1999;47(1):122-123.

URL: http//www.geocities.com/tgoldberg/prevrecs.htm.

Updated 2009.

Maneuver

Evidence*

Recommendation (Source)

Grade*

SCREENING:**

 

 

 

Blood pressure

I

Every exam, at least every 1-2 y (USPSTF,AHA)

A

Cholesterol/lipids

I

Adults ~ every 5 years (NCEP, ACP, USPSTF)

A

Physician breast exam/breast self-examination

I

Annually >=40 (ACS); USPSTF insufficient evidence to recommend

I

Mammogram

I

Every 1-2 yrs >=40 (ACS,USPSTF);
Continue q1-3 yrs 70-~85 (AGS)***

B;
C>69

Pelvic exam/pap smear

I

Every 1-3 years after 2-3 neg. annual exams; can then decrease or D/C after age 65-70 (ACS, USPSTF,CTF,AGS)***

A;
C>65

Colorectal CA screening with FOBT, sigmoidoscopy, colonoscopy or BE

 

 

II

<>

FOBT annually, and/or sigmoidoscopy q5 yrs >= 50 or BEq5y OR colonoscopy q10y (ACS/Gastro, USPSTF). Stop at 75-85 (USPSTF)

<>

A

 

AAA

I

One time US for men 65-75 who have ever smoked (USPSTF)

B

 

Depression

III

Periodically in adults (USPSTF)

B

Test/inquire for hearing impairment

III

Periodically in older adults (Various)

C

Mouth, nodes, testes, skin, heart, lung exams

III

Annually (ACS,AHA) (USPSTF "I")

C

Glucose

III

Periodic in high-risk groups (USPSTF);
every 3y starting at 45 (ADA)

C

Thyroid function (TSH)

III

TSH q 5y for women >= 50 (ACP, USPSTF)

C

Electrocardiogram

III

Periodically >=40-50 (AHA)

C

Vision/Glaucoma screening

III

Periodically by eye specialist >=65 (USPSTF)

C

Mental/functional status

III

As needed; be alert for decline (USPSTF)

C

Osteoporosis

III

Periodically in post-menopausal women, men >70 (USPSTF/NOF)***

B

Prostate exam/PSA

III

Annually >= 50 if >10 yr life expectancy (ACS, AUA);
Insuff. Evidence/NR (USPSTF, ACP). Stop at 75 (USPSTF)

C
I

Chest x-ray

III

NR/as needed (ACS,USPSTF)

D

PROPHYLAXIS/COUNSELING

 

 

 

Exercise:

I-II

Encourage aerobic and resistance exercise (AHA, USPSTF "I")

A

Influenza vaccine:

I-II

Annually >=50 or chronically ill (ACP,USPSTF)

B

Pneumococcal vaccine:

I-II

23-valent at least once >= 65 (ACP,USPSTF)

B

Tetanus-diphtheria vaccine:

I-II

Primary series then booster every 10 yrs (ACP,USPSTF)

A

Calcium, Vit D, bisphosphonates for osteoporosis; estrogens not rec. for prevention of chronic illness.

 

II

Postmenopausal women (Various)

B
D

Aspirin:

I-II

Discuss with adults at increased risk of CHD, 80-325 mg qD/OD (Various)

A

Legend:

NR = Not recommended for routine prevention/screening in asymptomatic individuals, though may be useful when clinically indicated.

*Grades of evidence, USPSTF/CTF system:
I = Evidence from randomized trials
II = Evidence from non-randomized or retrospective studies
III = Expert opinions or other considerations.
3rd USPSTF (2002+) classifies evidence simply as Good, Fair, or Poor.

Classifications of recommendations:
A= Good evidence to support recommendation
B= Fair evidence to support recommendation
C= Poor evidence but recommendations may be made based on expert opinion or other policy considerations
D= Fair evidence to reject recommendation
E= Good evidence to reject recommendation.
I = Insufficient evidence to recommend for or against (Added by 3rd USPSTF 2002+)

**Screening recommendations for asymptomatic individuals; specific clinical circumstances may necessitate different testing and treatment schedules. Screening for occult disease may not be necessary/appropriate for the oldest old (over approx. 85) and others with limited quality & quantity of life.

***Medicare now covers screening for breast, cervical, prostate CA and osteoporosis based on the Balanced Budget Act of 1997.

References:

ACP: American College of Physicians Task Force on Adult Immunization. Guide for adult immunization, 3rd edition., 1994; American College of Physicians guidelines for using serum cholesterol, high-density lipoprotein cholesterol, and triglycerides as screening tests for the prevention of coronary heart disease in adults. Ann Intern Med 1996;124:515-517.; American College of Physicians. Screening for prostate cancer. Ann Int Med 1997;126:480-4. American College of Physicians. Screening for thyroid disease. Ann Int Med 1998;129:144-158.

ACS: Smith RA et al.  Cancer screening in the United States 2009: a review of current ACS guidelines and issues in cancer screening.   CA Cancer J Clin 2009;59:27-41. Available online at http://caonline.amcancersoc.org/misc/guidelines.shtml.

ADA: American Diabetes Association. Report of Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-1197. Available online at: http://www.diabetes.org./.

AGS: Clinical Practice Committee, American Geriatrics Society. Breast cancer screening in older women. JAGS 2000;48:842-844. Screening for cervical carcinoma in elderly women. JAGS 2001;49:655-657. AGS guidelines available online at: http://www.americangeriatrics.org/.

AHA: Grundy SM, Greenland P, Herd A, et al. Cardiovascular and risk factor evaluation of healthy American adults: a statement for physicians by an ad hoc committee appointed by the American Heart Association. Circulation 1987;75:1340A-1362A. Latest guidelines on prevention of cardiovascular disorders available online at: http://www.heart.org/.

AUA: American Urological Association. Prostate-specific antigen (PSA) best practice policy. Oncology 2000;14:267-286. AUA guidelines available online at: http://www.auanet.org/publications/best_practice/index.cfm.

CTF: Canadian Task Force on the Periodic Health Examination. Clinicians guide to preventive healthcare. Canadian Government Publishing, 1994. Available online at: http://www.ctfphc.org/.

Gastro: Winawer SJ, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale -- update based on new evidence. Gastroenterol 2003;124:544-560. Available online at: http://www.gastro.org/.  Levin B et al.  Screening and surveillance for early detection of colorectal cancer and adenomatous polyps, 2008: Joint guideline from the American Cancer Society, the US Multi-Society Talk Force on Colorectal Cancer, and the American College of Radiology.  CA Cancer J Clin 2008; Available online at http://caonline.amcancersoc.org/misc/guidelines.shtml.

NCEP: ATP III Report of the National Cholesterol Education Program Adult Treatment Panel III.  JAMA 2001;285:2486. Available online at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.html.

NOF: National Osteoporosis Foundation, http://www.nof.org/.

USPSTF: U.S. Preventive Services Task Force. Guide to clinical preventive services. Baltimore: Williams and Wilkins, 1989; 2nd ed., 1996; 3rd ed., 2005+.  Recommendations and updates available online at: http://www.ahrq.gov/clinic/uspstfix.htm.

All guidelines are also available at http://www.guideline.gov/.

(c) Todd H. Goldberg, M.D, 2009

 

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