Annual Laboratory Tests for Geriatric Patients
Annual laboratory tests for geriatric patients should include a comprehensive metabolic panel, complete blood count, lipid profile, hemoglobin A1C, urinalysis with albumin-to-creatinine ratio, and thyroid-stimulating hormone. 1
Core Laboratory Tests
- Complete Blood Count (CBC) with differential - screens for anemia, infection, and blood disorders commonly found in older adults 1
- Comprehensive Metabolic Panel (CMP) - assesses kidney function, liver function, and electrolyte balance, which are particularly important in geriatric patients who often have multiple chronic conditions 1
- Lipid Profile - includes total cholesterol, LDL, HDL, and triglycerides to assess cardiovascular risk, which remains significant in the geriatric population 1, 2
- Hemoglobin A1C - screens for diabetes and prediabetes, which affect over 29% of people over age 65 3
- Urinalysis with albumin-to-creatinine ratio - screens for kidney disease and urinary tract infections 1
- Thyroid-Stimulating Hormone (TSH) - particularly important for older adults as thyroid disorders increase with age 1
Age-Specific Considerations
- Prostate-Specific Antigen (PSA) - recommended annually in men aged 50+ years (earlier in high-risk men) 1
- Vitamin B12 levels - should be checked annually in patients taking metformin, which is common in older adults with diabetes 1
- Serum potassium levels - should be monitored in patients taking ACE inhibitors, ARBs, or diuretics, medications frequently prescribed to older adults 1
Screening for Geriatric Syndromes
- Annual screening for geriatric syndromes is recommended in older adults with diabetes, including assessment for 3:
- Cognitive impairment
- Depression
- Urinary incontinence
- Falls
- Persistent pain
- Frailty
- Polypharmacy
Special Considerations for Diabetes Management
- For geriatric patients with diabetes, more frequent monitoring is recommended 3:
- A1C test at least twice yearly if meeting treatment goals
- Quarterly A1C if therapy has changed or not meeting goals
- Annual urine albumin test
- Glycemic goals should be individualized based on functional status 3:
- A1C <7.5% for older adults who are otherwise healthy with few chronic illnesses and intact cognitive function
- A1C 8.0-8.5% for those with multiple chronic illnesses, cognitive impairment, or functional dependence
Cardiovascular Risk Assessment
- Blood pressure determination should be performed at every visit 1
- Women have a significantly higher prevalence of hypertension than men in the geriatric population (76.6% vs 63.0%) and require careful monitoring 2
- Dyslipidemia affects approximately 60% of older adults and should be regularly assessed 2
Common Pitfalls to Avoid
- Failing to recognize that "normal" laboratory values may differ in the elderly population - for example, serum alkaline phosphatase may be elevated up to 2.5 times normal in healthy elderly individuals 4
- Overlooking the need for more frequent monitoring in patients with multiple chronic conditions or on medications that affect laboratory values 1, 5
- Not considering the impact of polypharmacy on laboratory values - both under-pharmacy and poly-pharmacy are associated with decreased therapeutic benefit among elderly patients 5
- Failing to incorporate functional assessment alongside laboratory testing - studies show significant burden of functional impairment in older adults that impacts medical management 6, 7