What should a 72-year-old female's Medicare wellness exam include?

From the Guidelines

A 72-year-old female's Medicare Annual Wellness Visit should include a comprehensive approach to preventive care, focusing on health risk assessment, review of medical and family history, medication reconciliation, screening for depression and cognitive impairment, and personalized health advice. The provider should check vital signs including blood pressure, heart rate, weight, and height to calculate BMI. Preventive screenings appropriate for her age include mammograms (typically every 1-2 years until age 74) 1, colorectal cancer screening (colonoscopy every 10 years or other methods like FIT testing annually) 1, bone density testing for osteoporosis, and vision and hearing assessments. Vaccinations should be reviewed, ensuring she's up-to-date with pneumococcal vaccines, annual flu shots, shingles vaccine (Shingrix), and Tdap/Td boosters. The visit should include fall risk assessment, medication side effect discussions, and advance care planning conversations. Lifestyle counseling regarding diet, exercise, and smoking cessation is important. This comprehensive approach helps identify health issues early when they're most treatable and focuses on preventive care rather than just treating illness, which is particularly important as older adults often have multiple chronic conditions that benefit from regular monitoring. Some key points to consider are:

• The American College of Physicians recommends biennial screening mammography for women aged 50-74 years, particularly after age 55 years, to reduce the frequency of harms while still providing benefits 1.
• The American Cancer Society recommends that women with an average risk of breast cancer should continue screening mammography until at least age 75 years 1.
• Colorectal cancer screening should start at age 50 and can include various methods such as colonoscopy, FIT testing, or flexible sigmoidoscopy, with the choice of method depending on patient preferences and risk factors 1. Given the most recent and highest quality evidence, the best approach for a 72-year-old female's Medicare Annual Wellness Visit is to prioritize a comprehensive preventive care strategy that includes regular screenings, vaccinations, and lifestyle counseling, tailored to her individual needs and risk factors 1.

From the Research

Medicare Wellness Exam for a 72-year-old Female

A Medicare wellness exam for a 72-year-old female should include several components to ensure overall health and wellness.

• Vaccinations:
  • Influenza vaccine: Studies have shown that influenza vaccination can reduce mortality and cardiovascular events in adults with cardiovascular disease 2.
  • Pneumococcal vaccine: The Irish Immunisation Guidelines recommend that people with diabetes mellitus receive the pneumococcal vaccine, and studies have shown that GP recommendation is a significant predictor of pneumococcal vaccine uptake 3.
• Health Risk Assessments:
  • Assessment of cardiovascular disease risk: Given the high prevalence of cardiovascular disease in older adults, assessing risk factors such as hypertension, diabetes, and hyperlipidemia is crucial 4.
  • Assessment of diabetes risk: As diabetes is a significant risk factor for cardiovascular disease, assessing diabetes risk and providing recommendations for management is essential 4.
• Preventive Services:
  • Screening for chronic conditions: Screening for conditions such as hypertension, diabetes, and hyperlipidemia can help identify risk factors and prevent complications 4.
  • Counseling on healthy lifestyle habits: Providing counseling on healthy lifestyle habits such as diet, exercise, and stress management can help prevent chronic conditions 4.
• Medication Management:
  • Review of medications: A review of medications can help identify potential interactions and ensure that medications are being used effectively 5.
  • Counseling on medication adherence: Counseling on medication adherence can help improve health outcomes and prevent complications 5.

Special Considerations

• Age-related considerations: As people age, they are at increased risk for chronic conditions such as cardiovascular disease and diabetes. Therefore, age-related considerations such as screening for age-related diseases and providing recommendations for healthy aging are essential 3, 2.
• Comorbidities: The presence of comorbidities such as diabetes and hypertension can increase the risk of complications. Therefore, assessing and managing comorbidities is crucial 4, 6.