Monday Medical: Preventive health for adults over 65
For Steamboat Pilot & Today
Editor’s note: This is part 3 of a three-part series on preventive health recommendations. Part 1 covered preventive health recommendations for adults ages 20 to 50, and part 2 covered recommendations for adults ages 50 to 64.
For people ages 65 and older, preventive medicine is more important than ever. Dr. Sarah Hopfenbeck, an internal medicine physician in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center, outlines what older adults need to know about taking care of their health below.
It’s recommended that all patients see their medical provider each year for a physical.
Through Medicare, patients are eligible for a one-time initial preventive physical exam. After that initial exam, Medicare covers an annual wellness visit. This exam is sometimes done by nurses, and while it doesn’t include a hands-on physical exam, it’s a chance to review routine health maintenance and screen a patient for risks of falls, depression and cognition issues. Advanced directives also are discussed. The wellness exam should be followed up by an office visit with the provider to discuss results and for an actual exam.
Mammograms are recommended every one to two years for women ages 65 and older.
“Personally, I recommend an annual mammogram,” Hopfenbeck said. “But it’s true for any of these tests that we like to participate in shared decision-making. Instead of directing a patient to do something, we have a conversation about what various organizations recommend, what we recommend and what the patient feels.”
For women older than 65, Pap smears to screen for cervical cancer are generally no longer recommended, though women who smoke or have new sexual partners should continue with the test.
Men in this age group are generally screened for prostate cancer through a blood test for prostate-specific antigen, or PSA, every one to two years.
Both men and women at average risk for colon cancer should continue with screening for the disease by having a colonoscopy every 10 years or the at-home Cologuard stool test every three years. High-risk individuals should be screened with a colonoscopy more frequently.
Typically, cancer screenings cease when a patient has a life expectancy of less than 10 years.
“There’s no crystal ball. I have patients in their 90s who are going strong, and if I had told them to quit screening 20 years ago, that may not have been appropriate,” Hopfenbeck said.
“But some people will say, ‘If I get something at this stage in my life, I’m not going to treat it.’ It’s very important to talk with each person in terms of where they stand with their health, what their goals are, what they want their life to be like.”
A bone density test to screen for osteoporosis is recommended for women older than 60, as well as for some men with risk factors, such as smoking or steroid use. If results are normal, the test may be repeated every 10 to 15 years, depending on risk factors. Checks every two to three years are recommended for patients who have low or decreasing bone mass.
Recommendations are similar to those for younger adults, with the addition of a high dose flu shot each year, as well as the pneumonia vaccine, which is recommended once at 65 and boosted every 10 years or more frequently for people with chronic health conditions.
Older adults may take a range of medications, and it’s important to regularly review that list.
“As people get older, they don’t tolerate some medications as well, and others could have potential interactions,” Hopfenbeck said. “It’s good to sit down with your doctor each year and see which medications you’re on and if they’re all necessary.”
The old adage holds — an ounce of prevention is worth a pound of cure.
“It remains true in older adults that the earlier we pick things up, the sooner we can do something about them,” Hopfenbeck said. “We know that as our bodies age, the incidence and risk for a lot of these things, such as breast cancer and prostate cancer, increase. We want to do everything we can to help people age gracefully and in a healthy way.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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