Recommended Routine Screenings for a 75-Year-Old Patient in Primary Care
For a 75-year-old patient who hasn't been seen in primary care for a while, I recommend implementing a comprehensive geriatric assessment along with age-appropriate cancer screenings, focusing on colorectal cancer screening, cardiovascular risk assessment, and sensory function evaluation.
Comprehensive Geriatric Assessment (CGA)
A CGA is essential for older adults to identify and manage geriatric conditions and syndromes. This multidimensional assessment should include:
- Functional status assessment: Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)
- Cognitive screening: Using validated tools like Mini-Cog or Montreal Cognitive Assessment
- Mobility and fall risk assessment: Timed Up and Go test
- Medication review: Identify polypharmacy, inappropriate medications, and drug interactions
- Nutritional status: Weight, BMI, and nutritional screening
- Social support evaluation: Living situation, caregiver availability
- Mood assessment: Screen for depression and anxiety
CGA has been shown to reduce the risk of unplanned hospital admissions by 17% and hospital care days by 22% in high-risk older adults 1, 2.
Cancer Screenings
Colorectal Cancer Screening
Colorectal cancer screening is recommended for this 75-year-old patient through one of the following methods 3:
- Fecal occult blood testing (FOBT) yearly
- Flexible sigmoidoscopy every 3-5 years
- Colonoscopy every 10 years
- Double-contrast barium enema every 5-10 years
Medicare covers colorectal cancer screening for individuals over 50 years, with FOBT reimbursed annually and flexible sigmoidoscopy every 4 years (or every 2 years for high-risk patients) 3.
Breast Cancer Screening
For a 75-year-old woman, biennial mammography screening should be considered, as the USPSTF recommends biennial screening mammography for women aged 50-74 years 4. After age 74, the decision should be based on the patient's overall health status and life expectancy.
Cervical Cancer Screening
Routine cervical cancer screening can be discontinued after age 65 if the patient has had adequate prior screening with normal results 3. If the patient has never been screened or has had inadequate screening, consider Pap testing.
Prostate Cancer Screening
For a 75-year-old man, discuss the potential benefits and harms of prostate cancer screening. Medicare covers annual digital rectal examination and PSA testing in men older than 50 years 3, but the decision should be individualized based on health status and preferences.
Cardiovascular Assessment
- Blood pressure measurement and hypertension management
- Lipid profile assessment
- Diabetes screening with fasting glucose or HbA1c
- Electrocardiogram if indicated by symptoms or risk factors
- Assessment for atypical presentation of acute coronary syndromes, as elderly patients often present with shortness of breath (49%), diaphoresis (26%), nausea/vomiting (19%), or syncope (24%) rather than chest pain 3
Vision and Hearing Assessment
- Vision screening: The USPSTF concludes that evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults (I statement) 3, but clinical judgment suggests basic visual acuity testing is appropriate
- Hearing assessment: Basic hearing screening with whispered voice test or audiometry if indicated
Immunizations
- Influenza vaccine annually
- Pneumococcal vaccines according to current recommendations
- Tetanus-diphtheria booster if needed
- Shingles vaccine if not previously received
- COVID-19 vaccination status update
Bone Health
- DEXA scan for osteoporosis screening if not done recently
- Vitamin D level assessment
- Fall risk assessment and prevention strategies
Special Considerations for Elderly Patients
- Elderly patients often present with atypical symptoms of disease 3
- Treatment decisions should be tailored according to estimated life expectancy, patient wishes, and comorbidities 3
- The G8 questionnaire is a simple screening tool recommended by the EORTC Task Force for Cancer in the Elderly, taking only about 5 minutes to complete 3
Follow-up Planning
Based on the CGA findings, develop a coordinated care plan with appropriate follow-up intervals for identified issues. Regular reassessment is crucial, particularly for patients with multiple chronic conditions.
Implementation of CGA in primary care has demonstrated reduced healthcare costs, with an adjusted mean difference of €4324 lower in intervention groups receiving CGA compared to usual care 2.