Recommended Annual Laboratory Tests for the Geriatric Population
The core annual laboratory tests recommended for geriatric patients 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 to screen for anemia, infection, and blood disorders commonly found in older adults 1
- Comprehensive Metabolic Panel (CMP) to assess kidney function, liver function, and electrolyte balance, which are particularly important in geriatric patients with multiple chronic conditions 1
- Hemoglobin A1C to screen for diabetes and prediabetes, which affect over 29% of people over age 65 1
- Lipid profile for cardiovascular risk assessment 1, 2
- Urinalysis with albumin-to-creatinine ratio to screen for kidney disease and urinary tract infections 1
- Thyroid-Stimulating Hormone (TSH) as thyroid disorders increase with age 1
Diabetes Screening and Monitoring
- For geriatric patients without diabetes, screening should be performed at least every 3 years if tests are normal 3
- For those with prediabetes, annual testing is recommended 3
- For geriatric patients with diagnosed diabetes 3, 1:
- A1C testing at least every 6 months if meeting treatment goals
- More frequent A1C testing (quarterly) if therapy has changed or not meeting goals
- Target A1C of 7.5-8% for most older adults with diabetes
- Higher A1C targets (8-9%) for older adults with multiple comorbidities, poor health, and limited life expectancy
Cardiovascular and Renal Monitoring
- Blood pressure measurement at every visit 1, 2
- For patients on ACE inhibitors or ARBs: renal function and serum potassium levels should be checked 1-2 weeks after initiation, with each dosage increase, and at least yearly 3
- For patients on thiazide or loop diuretics: electrolytes should be checked 1-2 weeks after initiation, with each dosage increase, and at least yearly 3
- Kidney function assessment requires special consideration in geriatric patients, as GFR naturally declines with age and may not reflect true CKD without albuminuria 4
Cancer Screening
- Colorectal cancer screening for individuals older than 50 years 3:
- Annual fecal occult blood testing
- Flexible sigmoidoscopy every 4 years (or every 2 years for high-risk patients)
- Colonoscopy every 2 years for high-risk patients
- Prostate cancer screening for men older than 50 years 3, 1:
- Annual digital rectal examination
- Annual prostate-specific antigen (PSA) test
- Breast cancer screening: annual mammography for women older than 40 years 3
- Cervical cancer screening 3:
- Pap testing every 3 years until age 65-70
- May be discontinued after age 65 in women with consistently normal previous tests
- Not required in women who have undergone hysterectomy with cervix removal (unless for cervical cancer)
Additional Considerations
- Vitamin B12 levels should be checked annually in patients taking metformin 1
- Serum potassium monitoring for patients on ACE inhibitors, ARBs, or diuretics 1
- Consider age-adjusted interpretation of laboratory values, as some parameters naturally change with aging 5, 6:
- Hemoglobin levels tend to decrease (lowest acceptable level: 11.0 g/dL in women, 11.5 g/dL in men)
- Serum creatinine may remain normal despite decreased creatinine clearance
- Fasting blood glucose may be elevated (up to 135-150 mg/dL)
- Erythrocyte sedimentation rate may be higher (up to 40 mm/hr)
Screening for Geriatric Syndromes
- Annual screening for cognitive impairment for adults 65 years and older 1, 2
- Assessment for depression, urinary incontinence, and persistent pain 1
- Functional assessment to evaluate impact on activities of daily living 7
By implementing these recommended annual laboratory tests, healthcare providers can effectively monitor and manage the health of geriatric patients, leading to improved outcomes and quality of life.