Health Maintenance/screening In The Elderly
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More Specific Terms
History
- screen for depression ( USPSTF & )
- alcohol screen ( USPSTF)
- inquire about symptoms of hypothyroidism ( USPSTF)
- inquire about hearing loss ( USPSTF)
- inquire about lower extremity claudication ( USPSTF)
- physical disability screening ( USPSTF & ACP)
- inquire about falls () {yearly}
- dementia screening (only if symptomatic)
Physical-examination
- height-weight monitoring
- blood pressure screening
- full skin examination by dermatologist {high-risk patients}
- hearing screening - Whisper test
- vision screening - insufficient evidence ( USPSTF) [5]
- Snellen chart
- retinal exam
- intraocular pressure measurement by ophthalmologist
- oral exam in smokers & alcoholics
- thyroid palpation, if history of radiation exposure
- fall evaluation
- comprehensive geriatric assessment
- home safety evaluation
- digital rectal exam NOT recommended for
- screen for colorectal cancer ( AHCPR)
- screen for prostate cancer ( USPSTF)
- pelvic exam NOT recommended to screen for ovarian cancer
Laboratory
- ( USPSTF)
- thyroid-stimulating hormone { TSH} not indicated [3]
- diabetes screening { chem7}
- lipid panel
- mortality in patients> 65 years of age not associated any lipid measurement [2]
- HDL inversely associated with myocardial infarction (hazard ratio = 0.85) in patients> 65 [2]
- PPD ( SNF residents, Alaskan natives, Native Americans)
- screening for colon cancer until life expectancy < 10 years
- yearly fecal occult blood
- routine urinalysis NOT recommended
- screening for urinary tract infection
- screening for bladder cancer 7 routine CBC NOT recommended for anemia screening
Diagnostic-procedures
- ( USPSTF)
- PPD ( SNF residents, Alaskan natives, Native Americans)
- routine screening EKG NOT recommended
- routine endometrial biopsy NOT recommended for uterine cancer screening
Radiology
- ( USPSTF, except DEXA: , )
- screening for colon cancer until life expectancy < 10 years
- yearly fecal occult blood
- flexible sigmoidoscopy every 5 years
- air contrast barium enema every 5-10 years {may be done in conjunction with flexible signmoidoscopy}
- colonoscopy every 10 years
- bone density { DEXA} for all caucasian women
- mammogram every 2 years until life expectancy < 10 years
- routine transvaginal ultrasound NOT recommended for ovarian cancer screening
Management
- influenza vaccine (also for health care workers)
- tetanus booster every 10 years
- pneumococcus vaccine
- hepatitis A vaccine (Native Americans & Alaskan natives)
- hepatitis B vaccine ( dialysis patients)
- influenza prophylaxis if an outbreak in SNF
- aspirin 81 mg QD (5 year risk of CVD > 3%, 15 year risk > 15%)
- calcium & vit D for women > 50 years ()
- statins
- medication review, polypharmacy common [4]
- also see health risk factor
- smoking cessation
- use of seat belts ( USPSTF)
- avoid alcohol/drugs before driving/boating/swimming ( USPSTF)
- dental hygiene ( USPSTF)
- diet & exercise ( USPSTF)
- avoid sun overexposure {high-risk patients} ( USPSTF)
- reduce water heater setting to 120 degrees F ( USPSTF)
- install smoke detectors & change batteries yearly ( USPSTF)
- advanced directives counseling
More General Terms
Additional Terms
References
- A Karlamangla, UCLA Multicampus Program in Gerontology & Geriatrics, lecture series, March 21, 2002
- Journal Watch 24(23):176-77, 2004 Psaty BM, Anderson M, Kronmal RA, Tracy RP, Orchard T, Fried LP, Lumley T, Robbins J, Burke G, Newman AB, Furberg CD. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study. J Am Geriatr Soc. 2004 Oct;52(10):1639-47. PMID: [1]
- Journal Watch 25(2):18, 2005 Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frolich M, Westendorp RG. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004 Dec 1;292(21):2591-9. PMID: [2]
- Hajjar ER, Hanlon JT, Sloane RJ, Lindblad CI, Pieper CF, Ruby CM, Branch LC, Schmader KE. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc. 2005 Sep;53(9):1518-23. PMID: [3]
- U.S. Preventive Services Task Force. Screening for impaired visual acuity in older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009 Jul 7; 151:37. [4] PMID: [5]
- Chou R et al Screening older adults for impaired visual acuity: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009 Jul 7; 151:44. [6] PMID: [7]
