From the Guidelines
For a 74-year-old female with hyperlipidemia, hypertension, osteoarthritis, prediabetes, and restless leg syndrome at her annual wellness visit, several key screenings are appropriate, including blood pressure measurement, lipid panel testing, hemoglobin A1C, bone mineral density testing, depression screening, cognitive assessment, vision and hearing screenings, fall risk assessment, and medication review, as well as individualized cancer screenings, to prioritize her morbidity, mortality, and quality of life outcomes. The patient's hyperlipidemia and hypertension management should be assessed through regular lipid panel testing and blood pressure measurements, with targets generally below 130/80 mmHg for her age and comorbidities, and LDL levels below 70-100 mg/dL depending on her cardiovascular risk 1. Given her prediabetes diagnosis, hemoglobin A1C should be checked to monitor her condition, with a goal of keeping it below 6.5% 1. Bone mineral density testing is recommended for women her age to screen for osteoporosis, particularly with her osteoarthritis diagnosis 1. Depression screening using a tool like the PHQ-9 is important as depression is common in older adults with chronic conditions, and cognitive assessment using a brief screening tool should be performed to detect early cognitive changes 1. Vision and hearing screenings are appropriate given her age, and fall risk assessment is crucial, especially considering her osteoarthritis 1. Medication review should be conducted to evaluate for potential interactions, particularly with her multiple chronic conditions. Additionally, cancer screenings including colorectal cancer screening (colonoscopy every 10 years or alternative methods like FIT testing annually), and breast cancer screening with mammography should be considered, though these may be individualized based on her overall health status and life expectancy 1. These screenings are essential for preventive care and managing her existing conditions effectively, prioritizing her morbidity, mortality, and quality of life outcomes. Key considerations include:
- Regular monitoring of her chronic conditions to prevent complications and improve quality of life
- Individualized cancer screenings based on her overall health status and life expectancy
- Medication review to minimize potential interactions and optimize her treatment plan
- Fall risk assessment and prevention strategies to reduce her risk of injury
- Cognitive and depression screening to detect early changes and provide appropriate support.
From the Research
Annual Wellness Visit Screenings
For a 74-year-old female with hyperlipidemia, hypertension, osteoarthritis, prediabetes, and restless leg syndrome (RLS), the following screenings are appropriate:
- Blood pressure monitoring to assess hypertension control 2
- Lipid profile to monitor hyperlipidemia 2, 3
- Blood glucose monitoring to assess prediabetes control 3
- Osteoarthritis assessment to monitor joint health and pain management 3
- Restless leg syndrome (RLS) assessment to monitor symptoms and treatment efficacy 4, 5, 6
Cardiovascular Health
Considering the patient's history of hyperlipidemia and hypertension, cardiovascular health screenings are crucial:
- Monitoring of blood pressure and lipid profiles to assess cardiovascular risk 2
- Assessment of endothelial function to evaluate cardiovascular health 5
Musculoskeletal Health
Given the patient's osteoarthritis diagnosis, musculoskeletal health screenings are essential:
- Assessment of musculoskeletal fitness and function using tests such as the 30-s Chair Stand Test and Timed Up and Go test 3
- Monitoring of knee pain and joint health to evaluate osteoarthritis progression 3
Metabolic Health
To monitor the patient's prediabetes and metabolic health:
- Fasting blood glucose testing to assess glucose control 3
- Monitoring of liver function and lipid profiles to evaluate metabolic health 3
Restless Leg Syndrome (RLS) Management
To manage the patient's RLS symptoms: