Preventive Measures—at Any Age?
The older you get, the fewer health screenings are recommended. But don’t relax just yet. Maintaining good health requires more than just screenings.
The adage, “An ounce of prevention is worth a pound of cure,” reigns supreme in healthcare—at least in the first six decades of life. But once you’ve navigated your way to your seventies, eighties or beyond, isn’t it time to relax and enjoy life, to stop worrying about annual checkups and screening procedures?
Yes, and no.
Rightly, later in life the primary goals of your health care will shift to focus less on disease prevention, more on disability prevention. So while some health screenings continue to make sense—among them blood pressure and blood sugar monitoring—others aren’t necessary. And while you should discuss the merits of screening procedures with your doctor, ultimately, the decisions are up to you.
Who Recommends What?
Unfortunately, health professionals disagree somewhat in their recommendations regarding screening procedures. And to be fair, there are no clear-cut answers.
For example, the United States Preventive Services Task Force (USPSTF), convened by the Public Health Service, found good evidence that screening for ]]>prostate cancer]]> using ]]>prostate specific antigen (PSA)]]> testing or digital rectal examination (DRE) can detect early-stage prostate cancer. However, USPSTF also found mixed and inconclusive evidence that early detection improves health outcomes. Because PSA and DRE screenings have been linked with significant harms, including frequent false-positive results leading to unnecessary biopsies, the task force ultimately concluded that the “evidence is insufficient to determine whether the benefits outweigh the harms” of screening. Which means it’s up to you to weigh the benefits and risks.
In other cases, preventive screenings provide benefits that obviously outweigh the risks. Blood pressure screening is one of them. The USPSTF concluded that the benefits of screening for, and treating, ]]>high blood pressure]]> “substantially outweigh the harms.” Similarly, USPSTF found that osteoporosis screening makes sense for all women over age 65. The risk for osteoporosis and fractures increase with age, and the benefits of both screening and treatment are significant.
Still, other screenings fall into a murkier category. Screening for ]]>colon cancer]]> (also known as colorectal cancer) is one of those.
A Clear Recommendation, but Many Choices, Regarding Colon Cancer
Colon cancer is the second deadliest form of cancer. (Lung cancer is the deadliest form.) According to the American Cancer Society, “30,000 lives could be saved each year if everyone over age 50 got tested for colon cancer.”
While health care organizations generally agree that screening offers clear benefits—the five-year survival rate hovers near 90% when the disease is detected early, and drops to less than 10% when detected in a later stage—medical professionals disagree somewhat on what testing measures are best. Which means you’re wise to submit to screening, but what kind?
In general, an annual ]]>fecal occult blood test (FOBT)]]> or fecal immunochemical testing (FIT) is recommended. Many doctors, and the American Cancer society, also suggest that a ]]>colonoscopy]]>, ]]>flexible sigmoidoscopy]]>, or double-contrast barium enema be done every five or ten years. Also, home testing kits and new lab technologies are becoming available. Because colon cancer is a significant threat, and because very good treatment options exist, the bottom line is that you should get screened, regardless of advanced age.
Admittedly, colon cancer screening is about as popular with patients as root canal surgery. Therefore, the best test option to choose is probably the one you know you will actually have done. Discuss the various testing options with your doctor, but not for long. When it comes to colon cancer, getting a screening of any kind is better than not getting one at all.
Making Sense, and Your Senses
“The mind plays an integral role in our health,” says Paul Takahashi, MD, a specialist in geriatrics at Mayo Clinic, Rochester, Minnesota. Myriad studies have proven this is more than wishful thinking. New nerve connections continue to form in the brain throughout life. And like other parts of your body, you should have your brain assessed periodically.
The good news is that assessments of your mental state and your senses are simple, and painless. Your doctor may have conducted one, or several, over previous office visits.
To determine the state of your mental health, your doctor may ask you questions about current affairs, or may ask you to count backwards from 20 (or a higher number) to 1. To assess your general function, your doctor may ask specific questions about mobility, including how you get up from a chair, use stairs, or may ask about your bowel and other toilet habits. To gage the functioning of your senses, your doctor will consider your eye and hearing tests, and will also ask specific questions such as how you recognize faces across a room, or your ability to transfer an object from one hand to the other.
Ask about these assessments—and how you’ve scored—at your next visit. The most important things to watch in these assessments is the amount and pace of any changes noted.
Beyond Screenings, What Should You Do?
While some screenings clearly benefit older persons, others are not necessary for the majority of persons over age 70. But your health still depends greatly—in some cases, more now than ever—on following a few very fundamental pieces of preventive health advice.
- Quit smoking, or don’t start. According to the Center for Disease Control (CDC), “smoking cessation has major and immediate health benefits for men and women of all ages, regardless of whether they have a smoking-related disease.”
- Exercise, even if you never have before. Studies show that maintaining or even beginning an exercise routine is beneficial at any age. (Regardless of age, any individual should discuss appropriate physical activity with his or her doctor before beginning an exercise program.) The American Academy of Orthopaedic Surgeons (AAOS) recommends doing some physical activity every day. Among the benefits the AAOS cites: stronger bones, improved mobility and balance, reduced joint and muscle pain, and reduced risk of falls and resulting injuries.
- Eat right. Take your diet seriously, making every effort to get adequate amounts of fiber and to limit saturated and hydrogenated fat and salt intake.
- Don’t skip immunizations. Influenza and pneumonia vaccines prevent hospitalization and death in the elderly population, and potential risks are minimal.
- Maintain a thorough, personal medical file. As we age, our medical care increasingly is handled by a series of specialists. Unfortunately, because of this, your primary care physician may not be fully aware of your medical conditions and ongoing treatment. Maintaining a complete and current listing of all of your treatments, including prescriptions and over the counter medicines, as well as diet and exercise routines, is more important than ever. Take your records with you each time you see a doctor.
Which Screenings Are Necessary for Those Ages 70 and Up?
Some screenings are important, for almost everyone, even over age 70. Other screenings are recommended based on individual factors.
|Tests you should get:|
The USPSTF has concluded that the benefits outweigh the harms for these tests, and treatment for the disorders for which they screen is beneficial to most people, regardless of age and especially in older adults.
|Test you might want to get:|
Those who have certain risk factors should discuss these tests with their doctors.
|Tests you probably don’t need:|
For the general population, USPSTF concluded there is insufficient evidence to recommend for or against these tests. The USPSTF recommends selected high-risk patients discuss these tests with their doctors.
Agency for Research & Quality in Healthcare
American Cancer Society
National Institute on Aging
National Institutes of Health
Canadian Public Health
The College of Canadian Family Physicians
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Expand your mind: A healthy habit for young aging. Mayo Foundation website. Available at: http://www.mayoclinic.com/health/senior-health/HA00021 . Accessed November 1, 2005.
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Staying active as you age helps you remain healthy, live longer and feel better. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_id=22&topcategory=Wellness . Accessed November 3, 2005.
Zagaria MA. Senior Care: Recommended Screenings for Older Adults. US Pharmacist. Available at: http://www.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/ACF363B.htm&pub_id=8&article_id=841 . Accessed November 1, 2005.
Last reviewed May 2009 by ]]>Igor Puzanov, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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