It's always better to prevent an illness rather than treat it after it develops. And while some factors (such as your age, gender, and family history for certain diseases) are outside our control, there are many important risk factors that are within our power to change. Steps like pursuing screening tests, vaccinations, and healthy lifestyle habits can help prevent or slow down an illness. Making small changes in your daily life can help you stay active and independent as you get older.
Screening for Common Diseases and Conditions
Below are general recommendations to help prevent illness in older adults. These guidelines can change over time as our understanding of diseases increases. Some screening tests may need to be done more frequently, depending on your specific risk factors. Some screening tests recommended for older adults also may involve short questionnaires or written tests.
High Blood Pressure
The chances of developing high blood pressure (hypertension) increase with age. Treating high blood pressure reduces the chance of stroke and heart attack. Your healthcare provider will check your blood pressure at least once each year.
Obesity increases the risk of many diseases, including heart disease, diabetes, and some cancers. Excess weight can also make pain from arthritis worse. If you are overweight or obese, your healthcare provider can work with you to reduce your weight to a healthy level to prevent these complications. (However, loss of weight that is not intentional and/or occurs rapidly can also be a sign of poor health.)
Seeing well will help keep you active and engaged with family and friends, less likely to fall, and able to enjoy life more fully. You should have your eyes examined by an eye doctor (ophthalmologist) once every year after the age of 65. If you have certain conditions, such as diabetes, you may need more frequent eye exams. The doctor will check for eye diseases that are common in older adults, including:
- Glaucoma: too much pressure within the eye
- Cataracts: clouding of the lens of the eye
- Macular degeneration: loss of central vision
Hearing loss can lead to a feeling of isolation and withdrawal from your social life. Modern hearing aids can help make the difference between feeling shut out of life and being part of the conversation again. An audiologist is a healthcare professional who treats hearing loss and other related disorders. An audiologist can check if you can benefit from hearing aids, and help with fitting and adjusting hearing aids so that they are comfortable and effective.
Diabetes is a disease that causes the amount of sugar (glucose) in your blood to be too high. Over time, diabetes can lead to many health conditions, and is a leading cause of blindness, kidney failure, and limb amputations. If you have risk factors for diabetes, such as being overweight, or having high blood pressure or cholesterol, your healthcare provider will do a blood test to screen for diabetes every 1-3 years. After the age of 70, regular screening is not usually recommended.
High cholesterol can increase the risk of heart disease and stroke. Screening for high cholesterol is recommended in older adults if they are at increased risk for heart disease because of other risk factors, such as smoking, high blood pressure, or a strong family history of heart disease.
Osteoporosis causes thinning and weakening of the bones that increases the risk of fractures. A bone density scan (a kind of X-ray) is recommended to test for osteoporosis in women 65 or older. (Although men can also get osteoporosis, it is less common than in women. Screening is only recommended in men if they have other risk factors for osteoporosis.)
Abdominal aortic aneurysm
An abdominal aortic aneurysm is a weakening in the wall of the aorta, the large blood vessel that carries blood from the heart to the rest of the body. It causes an bulging of the aorta that can grow over time and may start to leak or even rupture. Screening for abdominal aortic aneurysm (or AAA) is recommended in men age 65-75 who have ever smoked.
Depression is common in older adults, but often goes unrecognized. Older people often do not mention symptoms of depression, or may think the symptoms are just a normal part of aging. Depression can also be mistaken for fatigue or some other physical symptom. Your healthcare provider should ask a few questions about your general mood and emotional state at least once a year. If your provider thinks you may be depressed, you may be asked to complete a short questionnaire. Your answers will help you and your provider determine whether you would benefit from treatment, such as talk therapy or counseling, medication, or a combination of both.
For people over the age of 65, too much drinking can be harmful. Excessive drinking is considered to be consuming more than three drinks on one occasion, or more than 7 drinks per week. (This is for both men and women.) Excessive drinking increases your likelihood of injuries and accidents, diseases of the stomach, liver and pancreas, and dementia. Your healthcare provider should ask about your alcohol use at least once a year.
Dementia or cognitive impairment
Though some decline in mental function can occur with age, these normal changes should not get in the way of doing your usual activities. Your healthcare provider will periodically do a short test of your memory and thinking to see if any further testing should be done.
Screening for several types of common cancers is recommended to detect disease early, before there are any signs or symptoms. This is because treatment at an early stage is more likely to be successful. Cancer screening has important benefits, such as finding disease early and preventing deaths. However, it is important to remember that there are also harms associated with screening tests. These can include complications from the screening test itself, as well as fear and anxiety that could be caused by a false positive test. Screening may also identify a cancer that would never have caused symptoms or death. Treating these cancers with surgery, radiation, or chemotherapy can cause harm without providing any benefit.
The following recommendations are for people at average risk of disease. People at high risk, or people with a history of abnormal tests, may need screening earlier and more often.
Current recommendations are for women between the ages of 50 and 75 to have a mammogram every two years. Mammograms may be appropriate for women after the age of 75 who are healthy and expected to live for at least 10 more years.
There are several tests that can be used to screen for colon cancer. A colonoscopy is the most comprehensive test, and is recommended every 10 years for adults between the ages of 50 and 75. Other screening tests that may be used instead of a colonoscopy include CT colonography (“virtual colonoscopy”) or flexible sigmoidoscopy every 5 years, or testing of a stool sample once a year. Some people age 75-85 may benefit from screening if they are very healthy, or have never been screened. People over age 85 should not be screened.
A Pap smear to test for cervical cancer is recommended for women every 3-5 years. Screening does not need to be continued for women after the age of 65 if they have had regular normal screenings in the past 10 years. It also does not need to be continued for women who have had a hysterectomy (surgery to remove a woman's uterus or womb) for reasons other than cancer.
Screening for prostate cancer has been controversial because the disease usually progresses very slowly, and there is a lack of research to support the benefit of treatment early in the disease. Therefore, screening is no longer recommended for most older men. Your healthcare provider can advise you whether you should be screened for prostate cancer based on your risk factors.
Screening for lung cancer with a low-radiation dose CT scan once a year is recommended for people age 55-80 who are at high risk for the disease. People at high risk are those who have smoked the equivalent of one pack of cigarettes per day for 30 years, and either currently smoke, or who have quit within the past 15 years.
Because the immune system weakens with age, older adults are at higher risk for many diseases. Some of these common diseases can be prevented with vaccines. The following vaccines are recommended for most older adults. Your healthcare provider can tell you if there are additional vaccinations you should get based on your individual risk factors. In addition, some people cannot get certain vaccinations if their immune systems are severely weakened from medications or other diseases.
Up to 70% of hospitalizations and 90% of deaths from the flu occur in older adults. All older adults should get a flu shot every fall, at the start of the flu season.
There are two different types of pneumococcal vaccine recommended for adults 65 or older. They are called pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPSV)23. Older adults should receive both the PCV13 and PPSV23 vaccines, given at least one year apart. Only one dose of each vaccine is needed.
Tetanus, Diphtheria and Pertussis
Adults should receive a tetanus-diphtheria (Td) vaccine every 10 years. Adults age 65 and over should also receive one dose of the tetanus-diphtheria-pertussis (Tdap) vaccine. The pertussis part of the vaccine protects against whooping cough, so it is especially important for older adults who have close contact with infants under one year of age.
Shingles is a painful rash caused by the same virus that causes chicken pox. The rash usually appears as a band or strip on one side of the face or body. In some people, severe pain can persist even after the rash has healed. This persistent pain is called post-herpetic neuralgia and can last for many years. The risk of both shingles and post-herpetic neuralgia increases dramatically after the age of 50. The shingles vaccine reduces the risk of getting shingles, reduces the severity of shingles outbreaks, and reduces the risk of post herpetic neuralgia. The shingles vaccine is recommended once for adults age 60 and over, even if they have previously had shingles. However, people with weak immune systems due to illness or medications should not get the shingles vaccination.