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One of the most important steps in maintaining good health or at least minimizing any health related problems is to make routine visits to your doctor and get recommended annual exams and needed tests. The following recommendations are general guidelines regarding routine health related practices for elders.

*Note: Specific recommendations may vary for each individual based on age and health condition. Please discuss individual needs with the primary care physician.

Primary Care Physician (PCP)
See the PCP on a regular basis, at least every 6 months to a year if you are in good health with no or stable medical problems. If you have medical problems, see your PCP as directed and as needed.

The most important thing to remember is to see your PCP as often as he/she recommends. The physicians make their recommendations for follow-up visits based on the presence and status of your medical condition. These follow-up visits will assist him to effectively manage your medical problems and medications.

Physician Specialist
If the elder has been recommended to see or has seen a specialist for a specific medical condition, such as cardiologist (heart), pulmonologist (lung), nephrologist (kidney), etc, they should make routine follow-up appointments as recommended.

Annual physical exams
There has been debate about the value of an annual physical, but many PCPs continue to perform routine annual physical exams. If an elder has chronic health conditions, like many do, an annual physical exam is not necessary because they are seeing their PCP several times a year.

Influenza vaccine
Anyone 50 and over, people at high risk and people with heart or lung diseases should get a flu shot every year. Flu shots are usually given in the fall.

Pneumococcal vaccine
People who get the pneumonia shot before age 65, may need a 2^nd shot after they turn 65. Pneumonia shot should be repeated every 5 – 10 years. Check with your doctor for individualized recommendations.

Blood pressure measurement
It is important to routinely check for high blood pressure (hypertension). Hypertension is a very serious condition that if undetected, untreated or undertreated, can contribute to heart attacks, kidney problems, premature deaths and stroke. Recommendations say that blood pressure should be checked once every 2 years for those with blood pressure less than 120 / 80. More frequent monitoring is necessary for those with readings of 130/85 or higher. Of course, most elders have their blood pressure checked more frequently with their doctor’s appointments.

Cholesterol measurement
All adults should have their Cholesterol levels checked every 5 years. It should be checked more often if your total or LDL (“bad”) cholesterol is high, HDL (“good”) is low, and/or you have risk factors. Those individuals on cholesterol lowering medications should check with their doctor for recommendations on how often to monitor the cholesterol levels. Cholesterol blood tests must be done after fasting anywhere form 6-12 hours, check with the physician for instructions.

Diabetes screening (fasting blood glucose test)
Adults 45 and older should have their fasting glucose checked every 3 years, those at high risk should have theirs tested earlier. If the elder is not a diabetic, the PCP will probably check the fasting blood glucose at least every year with the annual visit. If the elder is a borderline, Type1 or Type 2 diabetic, more frequent testing will be recommended by the physician.

Hemaglobin a1c
This blood test is a valuable measure of the overall effectiveness of blood glucose control over a period of time. It gives an idea of how much sugar has been in the body for the preceding three months.  This blood test is usually done several times a year on individuals diagnosed with diabetes.

Colorectal cancer screening
These tests are useful to detect and remove precancerous polyps and identify cancers at an early stage. The most common screening tools are fecal occult blood tests, flexible sigmoidoscopy or colonsocopy. Occult blood screening is done annually, sigmoidoscopy and colonoscopy recommendations vary based on history of colon cancer. Please discuss the frequency and type of screening appropriate based on age and medical history.

Gynecological exam with Pap tests
Pelvic exams are recommended every year. Women 30 years and older who have had three consecutive negative (i.e., normal) Pap tests may be screened once every 2-3 years. It is reasonable for women from age 65-70 to stop having Pap tests if she has had three or more negative Pap tests in a row and no abnormal Pap tests in the past 10 years, this decision should be made with the advice of the physician. For women from age 65-70 over 30 who had 3 normal Pap test results may get screening every 2-3 years.

Mammogram
Women age 50 – 74 should get mammograms every other year until they turn 75; after age 75, the risks and benefits are unknown. There is no specific upper age limit to stop annual mammograms, the decision to stop annual mammography screening should be individualized and based on the context of overall health status and recommendations from the doctor.

Clinical breast exam (by a physician)
Clinical breast exams for women 40 and over are recommended every year. Breast self-exams are no longer recommended, but this doesn’t mean you should not check breasts regularly for any changes, lumps or secretions. If you notice a change, see your doctor.

Prostate cancer screening
Recommendations for digital rectal exam and PSA (prostate specific antigen) blood test vary depending on the individual’s desires, medical condition family history and age. Discuss options for screening with the PCP.

Osteoporosis screening
Guidelines suggest that postmenopausal women of any age and women over age 65 should be routinely screened for osteoporosis, otherwise known as Bone Density Testing. There is also some evidence that men over 70 should also be evaluated for the need for osteoporosis screening. Discuss with the PCP when osteoporosis screening should begin.

Dental exam
Full dental exam every 6 months and as needed. Many elderly people have tooth loss or ill-fitting dentures that result in chewing problems that can affect food intake. A dental exam should be done regularly even if the elder has dentures. A semi-annual trip to the dentist can treat and prevent problems that may affect overall health. 

Eye exam
Vision and disease screening every 1-2 years and as needed. 43 million adults will face significant vision loss or blindness from age related disease. Many diseases like glaucoma, macular degeneration, cataracts and diabetic retinopathy are treatable or curable if promptly diagnosed.

Ear exam
Ear exam and hearing test every 2 years and as needed if any loss of hearing is noted. Hearing impairment in both ears affects 1 in 3 adults over 65. Hearing loss is associated with social isolation, depression, loneliness and frustration. The mental, emotional and social consequences of untreated hearing loss negatively affect quality of life.

EKG or electrocardiogram
EKGs are usually done with an annual checkup and more often if there is a medical history of, family history of or risk factors for heart disease. Risk factors include, older age, high blood pressure, diabetes, high LDL (bad cholesterol) levels and smoking. The PCP or cardiologist will give specific recommendations.

The PCP or specialty physician may suggest additional testing, not mentioned above, based on individual risk factors, medical history and family history. If you accompany the elder to physician appointments (if not, call the office for the information), ask the doctor or office staff if they recommend any specific routine or annual testing. Keep a list of the recommendations and due dates from each physician. Some physician offices send out reminder letters for required testing but many do not so the burden falls on you to keep track of routine and annual needs from various physicians so nothing gets missed. Call to schedule the recommended tests as recommended.